You are a plural system with (IE)d4 additional personas (often called “headmates” or “alters”) sharing your consciousness, or “headspace.” Each alter can vary widely in preference, expression, orientation, gender, species, or even be more of an abstract concept, fictional character, or famous figure. Alters may have varying degrees of awareness of, attitude toward, and communication with each other. Alters usually alternate fronting (controlling the body and communicating externally), although co-fronting (multiple alters fronting at the same time) is possible, sometimes blending together while co-fronting. Some alters may never front but are still aware and communicate in headspace, and alters have different relationships with each other as any other social group does

The player cannot choose when to change which alter is fronting. (Such attempts will likely lead to Pain (Head) or Brain Fog.) Different alters tend to have circumstances by which they front, but not always, and alters can sometimes disappear for extended times. The player and GM may want to create a table of triggers that cause a shift in fronting, both triggers known to the character and seemingly random triggers known only to the GM. Note that the alter corresponding to a trigger may not be whom the player or party considers optimal, such as an alter with a phobia who always fronts and runs away in the presence of that stimulus while another with proficiency in Medicine may front at the sight of blood.

Alters may also communicate in headspace when not fronting, speaking to each other and to whomever is fronting but only audible in headspace. If you have at least one alter who can communicate with whomever is fronting, that alter can use their help action to give you advantage on Wisdom (Insight) checks.

When shifting which alter is fronting, if shifting to a cooperative alter who’s usually co-aware, the new alter can front without penalties. If the new alter has Amnesia relative to the previously fronting alter, they need a moment to assess the situation and will respond accordingly. If in combat, the disorientation requires one round, after which they act on initiative 1 with appropriate modifiers.

Over time, additional alters may appear. 1d4 days after life-changing events such as the end of a traumatic event or the end of a major adventure or campaign arc, roll 1d20. On rolling (IE) or less, you add another alter. This splitting is often accompanied by headaches, blackout, memory loss, and disorientation, and the new alter is usually confused when fronting for the first time.

When creating a plural system as a character, alter stats may vary, up to ±2 from the base stats, but should total the same number as the base. Alters may share a character class or have different classes and proficiencies for each (or some combination). Treat the character as multiclassed for level advancement, or keep separate experience points for each alter based on who was fronting during a given encounter or story beat. Some alters are likely noncombatants or may even be children. Or the player and GM may decide that all alters share an experience pool like a typical multiclassed character, depending how aware any given alter is when not fronting.

If you have other traits, you may assign them to one or more alters, both mental and physical. You may choose Amnesia (Anterograde), Amnesia (Traumatic), or Traumatic Flashbacks as one or more of your other traits for one or more alters. Note that awareness can vary by individual alter or groups of alters, so Amnesia may cluster, certain alters being aware or co-fronting while other alters have no memory of that time. Other Amnesia (usually Traumatic) may be universal to the entire system.

Plurality in the past was often called, “Multiple Personality Disorder,” but that term does not accurately describe the plural experience and is no longer used. Because plurality has as many expressions and variations as systems who experience it, including varying forms of cooperation and Amnesia, if you’re interested in representing a plural system, check out the Plurality Hub or Multiplicity and Plurality Wiki, and talk to your GM about your system and what modifications to these rules would be more representative.

Real-world Examples

Plurality (Parogenic, Endogenic, Gateway, Quoigenic, Paragenic, Traumagenic), Dissociative Identity Disorder

Assistive Options

Plural systems mostly need understanding from those around them and willingness to acknowledge the different alters as individuals the same way they would acknowledge multiple singular people. It’s helpful when communicating with a system to verify who is fronting but also to recognize that those not fronting are often conscious and aware of the external environment. While your physical appearances may change when switching alters (such as posture, facial movement, voice, or gait), each may sometimes use a visible accessory to help others know who is fronting, such as a pin, hat, or scarf, or an accessory may move from one position to another.

Your overall emotional state fluctuates between Amplified Emotion (Enjoyable) (30 percent) and Baseless Emotion (50 percent) or both at the same time (20 percent). These episodes happen according to the following table. If a frequency roll is smaller than the subsequent duration, your mood shifts over the course of 1d6 hours.

Real-world Examples

Bipolar Disorder

Assistive Options

By keeping a regular sleep schedule and eating regular healthy meals (not trail rations) for (IE) × 7 days, the duration of the episode decreases by 1d8 days (minimum 0). An ally spending a short rest supporting you each day by talking and listening to you during an episode will decrease the duration by 1d4 days.

You have a troubled relationship with food. Choose or roll on the following table.
Generate Random Eating Disruption

function displayRandom() { const eatingDisorders = [ 'Anorexia', 'Anorexia', 'Anorexia', 'Anorexia', 'Avoidant/Restrictive Food Intake', 'Avoidant/Restrictive Food Intake', 'Avoidant/Restrictive Food Intake', 'Binge Eating', 'Binge Eating', 'Binge Eating', 'Binge Eating', 'Bulimia', 'Bulimia', 'Bulimia', 'Night Eating', 'Night Eating', 'Orthorexia', 'Orthorexia', 'Pica', 'Rumination' ]; const randomIndex = Math.floor(Math.random() * eatingDisorders.length); const randomDisorder = eatingDisorders[randomIndex]; document.getElementById("eating-disorder").innerHTML = randomDisorder; }

• Anorexia. You avoid eating or eating certain foods due to a fear of gaining weight. When it’s time to eat, if you attempt to voluntarily or involuntarily eat a meal, you must succeed on a DC (IE) × 2 + 8 Wisdom saving throw or be unable to force yourself to. On success, you are able to eat a meal, but then must succeed on a DC (IE) × 2 + 5 Constitution saving throw or experience Baseless Emotion (Guilt) or Baseless Emotion (Panic) until you succeed on the saving throw, which you may make every (IE) × 10 minutes. Consult p. 87 of the Basic Rules or other fifth edition sources for the effects of not eating enough.
• Avoidant/Restrictive Food Intake. You avoid eating many foods either due to finding many foods distasteful possibly due to sensory reasons, or a fear that something bad might happen while eating them such as choking. Work with your GM to develop a list of 4d4 ÷ (IE) specific foods that you can eat without a problem. When it’s time to eat anything else, you must succeed on a DC (IE) × 2 + 8 Wisdom saving throw or be unable to force yourself to. Consult p. 87 of the Basic Rules or other fifth edition sources for the effects of not eating enough.
• Binge Eating. When you begin eating and have the opportunity, you will quickly continue to eat until uncomfortably full due to stress, anxiety, depression, or low self-esteem. To limit your eating to a healthy amount, you must succeed on a DC 10 + (IE) Wisdom saving throw. Following an eating binge, you feel lethargic and have a −(IE) penalty on initiative rolls for (IE) hours after. Every seven days of binging, your weight increases by one percent, and for every twenty percent increase, you experience a −1 penalty on Strength (Athletics) and Dexterity (Acrobatics) checks. If you have multiple traits, you may choose Baseless Emotion as one of them.
• Bulimia. Every 1d4 days, due to a fear of gaining weight, you eat large amounts of food until painfully full, then you purge it via vomiting, consuming a known laxative, or doing intense exercise during the next long rest. You must succeed on a DC (IE) × 2 + 8 Wisdom saving throw to avoid this behavior. This behavior results in damage to the digestive system. For every one hundred days of purging, you must succeed on a DC 8 + (IE) Constitution saving throw or develop a new Periodic IE 1 Digestive trait or, if you already have one, it increases by 1 IE up to IE 4, after which the frequency begins to increase. Five days of successfully avoiding purging will allow the body to heal one day of the cumulative total. Once the one-hundred-day threshold is met, the tally starts over, and the trait change becomes permanent unless you can refrain from purging for one hundred days, which reverses the effect by one frequency level until in remission. If you have multiple traits, you may choose Baseless Emotion as one of them.
• Night Eating. Similar to Binge Eating, you eat excessively, but during a long rest, 1d6 hours after falling asleep or the equivalent. This disrupts the long rest and requires starting the rest over after eating due to indigestion. To limit your eating behavior, you must succeed on a DC 10 + (IE) Wisdom saving throw. Following an eating binge, you feel lethargic and have a −(IE) penalty on initiative rolls for (IE) hours after. Every seven days of binging, your weight increases by one percent, and for every twenty percent increase, you experience a −1 penalty on Strength (Athletics) and Dexterity (Acrobatics) checks.
• Orthorexia. You obsess over eating healthily according to a self-imposed diet not dictated by religion or culture due to past trauma, unhealthy relationships, anxiety, fearing a loss of control, low self-esteem or other internal conflicts. This leads to (IE) of the following accompanying traits:
  • Not eating enough food or the right kinds (See p. 87 of the Basic Rules or other fifth edition sources for the effects of not eating enough.)
  • Inability to eat in public, requiring a successful DC 10 + (IE) Constitution check to force yourself to do so
  • A Baseless Emotion based on not living up to your personal expectations. (This trait can be chosen more than once, reflecting multiple emotions)
• Pica. You crave non-food substances such as ice, dirt, soap, paper, hair, cloth, pebbles, or other materials that are not part of any cultural practice due to either mental health related reasons or malnourishment such as an iron deficiency. Every day, you must succeed on (IE) Constitution saving throws or consume (IE) ounces of the material when available. Depending on the material and quantity, the GM should determine whether a Constitution saving throw against poison is necessary. A typical effect of many materials results in Diarrhea on a failed DC 10 + (IE) Constitution saving throw. You might feel shame for indulging in your craving and try to do so in secret.
• Rumination. After eating, you regurgitate food, re-chew it, and either swallow or spit it out. As adults are more likely to spit it out than swallow it, besides bad breath and damage to the mouth and esophagus, you also risk the effects of not eating enough as with Anorexia and the long-term negative effects of Bulimia at the GM’s discretion. When you eat, you must succeed on a DC (IE) × 2 + 8 Wisdom saving throw to avoid this behavior. You experience a −(IE) penalty on all Charisma (Persuasion) checks for an hour after eating.

Real-world Examples

Anorexia Nervosa, Avoidant/Restrictive Food Intake Disorder, Binge Eating Disorder, Bulimia Nervosa, Night Eating Syndrome, Pica, Rumination Disorder

Assistive Options

The most important assistance for any of these is support from friends and allies, and a friend who has committed to helping and uses at least a short rest each day to offer encouragement and support gives advantage on saving throws on harmful urges for the day. Attempts by others to force a certain behavior will not eliminate the urge and will give you disadvantage on the next saving throw to resist.

Magical Assistance

The Goodberry spell can assist with malnutrition but still requires the same checks as other foods to consume and retain.

You have trouble understanding the nuances of different kinds of relationships, such as the difference between “friend” and “friendly,” so you tend to be overly trusting of people you don’t know and at the same time have trouble forming stable or meaningful bonds with others. This gives you a −(IE) penalty on all Wisdom (Insight) and Charisma (Deception) checks and saving throws against being charmed. Because of your trusting nature, you tend to be honest and expect it from others, which becomes clear when people interact with you, so they tend to trust you more as a result, giving you a +(IE) bonus to Charisma (Persuasion) checks with people who have interacted with you for at least ten minutes. These modifiers don’t apply to interactions with people with the same trait.

Real-world Examples

Autism, Reactive Attachment Disorder, Disinhibited Social Engagement Disorder

Assistive Options

You need allies who will help you navigate these social situations and keep you from putting yourself in danger.

You experience a lack of motivation to accomplish tasks that you need to do or usually enjoy doing. (Note: a task is a series of actions to accomplish a goal, not usually a single action.) This is not laziness — your subconscious is inhibiting your motivation. To begin a new task, you must succeed on a DC 8 + (IE) Wisdom check. You may reattempt a failed check every (IE)d4 minutes.

Real-world Examples

Depression, Schizophrenia

Assistive Options

A combination of factors can help. When you have at least three of the following, the IE reduces by 1:

• Allies who provide ongoing sincere encouragement throughout the day
• At least thirty minutes of exercise (as strenuous as walking) for five consecutive days
• Put your hands in soil, or eat a serving of non-alcoholic fermented food such as kombucha or yogurt
• Follow a daily routine
• Sleep for at least eight hours per night for five consecutive nights

You feel detached from your environment as if you’re in a dream or a fog, or as if a glass wall or veil separates you from your surroundings, although you’re aware that your experience doesn’t reflect reality. The world seems false and bland and may appear distorted, blurry, unusually clear, flat, or a different size. Sounds and time may likewise seem distorted. You have a +(IE) bonus to saving throws against Illusion magic since everything already seems like an illusion, but you have a −(IE) penalty on Wisdom (Perception) checks. If you have multiple traits, you may choose Baseless Emotions, Sensory Processing Difference, or Insomnia.

Real-world Examples

Derealization Disorder

Assistive Options

Assistance involves compassionate patience by trustworthy allies who acknowledge your experience.

You feel detached from your life, thoughts, and feelings, as if you’re watching a character in a performance. Your memory and sense of time and space, including your own shape, may change. At IE 4, you can’t recognize yourself in a mirror. You have a −(IE) penalty on Intelligence, Wisdom, and Charisma checks unless you take an extra (IE) × ten percent time to perform the check, and you have a −(IE) penalty on Constitution saving throws to maintain concentration. You have a +(IE) bonus to Constitution checks and saving throws, except to maintain concentration. You have resistance to being charmed or frightened, and when you gain a level of exhaustion, if you succeed on a DC 8 + (current exhaustion level) + (IE) Constitution saving throw, you can ignore its effects for one day, repeating the saving throw after each long rest, though you can still die at exhaustion level 6. If you have multiple traits, you may choose Amnesia, Insomnia, Baseless Emotion, Eating Disruption, and Alleviation Behavior as one or more of them.

Real-world Examples

Depersonalization Disorder

Assistive Options

Assistance involves compassionate patience by trustworthy allies who acknowledge your experience.

You have experiences or beliefs that others do not share, but you absolutely believe them to be true. Choose or roll on the following table. If you have multiple traits, you may choose or roll another Delusion trait or Intrusive Thoughts as one or more of them.

Trait

function displayTrait() { const rand = Math.floor(Math.random() * 100) + 1; let trait; if (rand >= 1 && rand = 7 && rand = 12 && rand = 18 && rand = 23 && rand = 30 && rand = 38 && rand = 45 && rand = 49 && rand = 56 && rand = 66 && rand = 74 && rand = 76 && rand = 83 && rand = 89 && rand = 97 && rand = 99 && rand <= 100) { trait = "Quick-motion phenomenon"; } document.getElementById("trait").innerHTML = trait; }

• Atmosphere. Something feels wrong about your environment, but you can’t figure out what, yet the feeling is undeniable. Because of your heightened awareness, you have a +(IE) on Wisdom (Perception) checks but a −(IE) penalty on Wisdom (Insight) checks.
• Awareness. You are intensely aware of a particular experience unrelated to your current circumstances or condition. Because of the distraction, you have a −(IE) penalty on initiative rolls, attack rolls and ability checks made as reactions, and Wisdom (Perception) checks.
• Control. You believe that you are being controlled, physically or mentally, by an external force. This causes a −(IE) penalty to Wisdom (Insight) checks.
• Dysmorphopsia. Straight lines or edges appear to be wavy to you. This altered perception gives you a −(IE) penalty on ranged attack rolls with at least partial cover.
• Erotomantic. You believe that someone, usually a public figure, is in love with you. You have a −(IE) penalty on Wisdom (Insight) checks related to this person, and you plan and act according to this belief.
• Grandiose. You believe that you are greater in some way than you are and act accordingly. This may manifest in a belief that you have a relationship with a famous being, that you are a famous being (past or present), or that you have exceptional talents, abilities, or powers. Some examples may include believing you have abilities of a character level higher than you’ve achieved, magic or proficiencies, or another character class that you don’t have. You will act on such beliefs unless convinced by an ally against following a specific harmful course of action, either through roleplay or an opposed Charisma (Persuasion) check by the ally.
• Ideas. You believe something fantastical to be true or that you are being affected by some kind of magic that is not in fact affecting you. The GM and player should discuss this and determine a specific belief. Depending on the belief, the game effects can vary widely, so find the trait that most closely reflects this belief, and adjust accordingly.
• Imposter. You believe that one or more important people in your life are imposters (actors playing the role of those people) and will act according to that belief. You will act on such beliefs unless convinced by an ally against following a specific harmful course of action, either through roleplay or an opposed Charisma (Persuasion) check by the ally.
• Intensity. You have a belief that is real, but you put an unreal amount of importance on it, such as a minor vermin infestation that you believe to be catastrophic. You will act on such beliefs unless convinced by an ally against following a specific harmful course of action, either through roleplay or an opposed Charisma (Persuasion) check by the ally.
• Jealousy. You believe that a friend or partner is betraying you. You will act on such beliefs unless convinced by an ally against following a specific harmful course of action, either through roleplay or an opposed Charisma (Persuasion) check by the ally.
• Macropsia. Objects appear (IE) × 20% larger than they are in real life. You have a −(IE) penalty on all attack rolls.
• Macrosomatognosia. Your own body feels (IE) × 20% larger than it is. You have a −(IE) penalty on all Dexterity checks, including Dexterity-based melee attack rolls.
• Memory. Your memory of (IE) events that happened is drastically different from reality. This can be part of your character’s backstory or historical events. You are convinced that your memory is accurate, and any evidence to the contrary is clearly fake or has some other explanation. To recall accurate details, you have a −(IE × 3) penalty in all Intelligence (History) checks related to that and related events.
• Micropsia. Objects appear (IE) × 20% smaller than they really are. You have a −(IE) penalty on all attack rolls.
• Microsomatognosia. Your body feels (IE) × 20% smaller than it really is. You have a −(IE) penalty on all Dexterity checks, including Dexterity-based melee attack rolls.
• Pelopsia. Objects seem closer than they are. You have a −(IE) penalty on all attack rolls and Dexterity (Sleight of Hand) checks.
• Persecutory. You believe that a person or object is trying to harm or work against you. You will act on such beliefs unless convinced by an ally against following a specific harmful course of action, either through roleplay or an opposed Charisma (Persuasion) check by the ally.
• Reference. You believe (IE) neutral environmental events or objects to have personal significance, that something is directed toward or connected to you when it isn’t. You will act on such beliefs unless convinced by an ally against following a specific harmful course of action, either through roleplay or an opposed Charisma (Persuasion) check by the ally.
• Somatic. You believe that you are sick or disabled and experience a range of physical symptoms. You struggle to acknowledge the underlying mental health related reasons (i.e., stress, trauma, etc.) that are causing these symptoms. While they feel real to you, no physical or magical cause can be found. Choose or roll another trait and IE for the delusional trait. You will experience the penalties associated with that trait unless convinced by an ally against following a specific harmful course of action, either through roleplay or an opposed Charisma (Persuasion) check by the ally. You do not typically receive any associated benefits from that trait unless agreed upon by both the player and GM. If you have multiple traits, you may choose this trait multiple times, each with a different delusional trait.
• Teleopsia. Objects seem further away than they are. You have a −(IE) penalty on all attack rolls and Dexterity (Sleight of Hand) checks.
• Quick-motion phenomenon. Time seems to go much quicker than it really is, as if the surrounding world is under a Haste spell. You have a −(IE) penalty on all initiative rolls and Dexterity (Sleight of Hand) checks and Wisdom (Perception) checks to hear details.

Note that the Zone of Truth spell will not counteract Delusions, as the person experiencing the delusion genuinely believes what they are saying as related statements are not deliberate lies.

Real-world Examples

Alice in Wonderland Syndrome, Capgras Syndrome, Schizophrenia, Dementia, Epilepsy, Parkinson’s Disease, Bipolar Disorder, Traumatic Brain Injury, Briquet's Syndrome, De Clérambault's Syndrome

Assistive Options

Allies who have spent at least (7 − their Charisma modifier) days with you receive a +1 to Charisma (Persuasion) checks to help you cope with delusions by recognizing behavioral pattern changes.

Magical Assistance

The Zone of Truth spell can help you with delusions when creatively applied, giving you +2 to related saving throws to temporarily disbelieve the delusions.

You become suddenly disoriented, losing track of where you are and how you got there, and are unable to concentrate. You have a −(IE) penalty on initiative rolls, attack rolls and ability checks made as reactions, Wisdom (Perception), Wisdom (Survival), and Constitution saving throws to maintain concentration. If the trait is Triggered, evening or sunset is a common triggering stimulus. If you have multiple traits, you may choose Attention Difference, Baseless Emotion (Restlessness), Hallucination, or Amnesia as one or more of them.

Real-world Examples

Dementia, Parkinson’s Disease, Kidney Disease, Liver Disease, Thyroid Disease

Assistive Options

If a party member uses the help action to orient the confused person, the IE decreases by 1 for 3d6 rounds.

Having multiple “disorders” can sometimes make it harder to cope with stressful situations. With OCD, anxiety, depression, and an immune disorder, sometimes it feels impossible to do normal things. But you just have to figure out a way to do it in your own way, get the tools you need, objects to focus on, an array of medications, and people you love that can help keep you grounded. That’s the real victory, living your own way the best you can.

-MicroBioDM

Display Emotion

function displaySymptom() { const symptoms = [ "Dread", "Guilt", "Hopelessness", "Irritability", "Loss of Interest", "Panic/Nervousness", "Restlessness", "Suspicion", "Worrying", "Worthlessness" ];

const randomSymptom = symptoms[Math.floor(Math.random() * symptoms.length)];

document.getElementById("symptom").innerHTML = randomSymptom; }

You feel 2d4 of these emotions without any necessary stimulus. In addition to the listed traits, any day that you experience these for more than four hours, you need to take a short rest or take one level of exhaustion due to the physical toll they take.

• Dread. You feel something looming, as if an unexpected event or entity will come to bring harm. Dread differs from worry in that it has an object, even if you don’t know what or who that object is. You have a −(IE) penalty to resist Charisma (Intimidation) checks and saving throws against the frightened condition.
• Guilt. You feel guilt, like you’ve done something wrong, even if you don’t know what it is, or excessive guilt over a minor offense. You have a −(IE) penalty on all Charisma (Persuasion) checks.
• Hopelessness. You have the overwhelming feeling that your circumstances will only get worse, either your immediate circumstances or your entire life or both (and which of those doesn’t matter). While experiencing this, you lose advantage on all ability checks.
• Loss of Interest. You don’t enjoy the activities that you used to and have trouble motivating yourself to do them. You have a −(IE) penalty on all proficiency bonuses (minimum 0 bonus).
• Panic/Nervousness. You have an overwhelming feeling of panic. All spell casting and ability checks require that you either succeed on a Constitution saving throw to maintain concentration or make the subsequent check with a −(IE) penalty, and tasks that normally require a Constitution saving throw are made with a −(IE) penalty.
• Restlessness. You feel agitated or panicked. Something is wrong, and maybe it’s related to a specific subject, or maybe not. Even if all evidence says things are fine, you have an unavoidable feeling to the contrary. This causes you to be hypervigilant, giving you a +(IE) bonus to all Wisdom (Perception) in contested Dexterity (Stealth) checks but a −(IE) penalty to notice harmless details.
• Suspicion. You worry about what people think of you and have trouble trusting people. You have a −(IE) penalty on all Wisdom (Insight) checks and a +(IE) bonus to resist being charmed.
• Worrying. You have an overwhelming fear of the future, both near and distant. You have a −(IE) penalty on saving throws against the frightened condition and a −(IE) penalty on Charisma (Persuasion) checks as your own doubt makes you less convincing to others.
• Worthlessness. You feel persistent self-doubt that your abilities or value as a person are inadequate. Trying to compare you to others only makes it worse. This makes you reluctant to take risks and causes you to second-guess your actions. This gives you a −(IE) penalty to initiative rolls.

Real-world Examples

Anxiety, Depression, Imposter Syndrome

Assistive Options

Several behavior changes can have a positive cumulative benefit. Upon keeping three of the following for seven days, the IE decreases by 1 as long as you maintain them: a set daily routine, set daily goals, exercise, eat a regular nutritious diet, get enough sleep on a regular schedule, and/or spend an hour each day doing something fun. If you change which you’re doing, at least three must stay the same, or you lose the benefit for seven days.