You have trouble choosing subjects to focus on and switching between them. Your mind unintentionally wanders, and you easily lose track of time. This leads to difficulties concentrating and indecision. This works the opposite when you’re focused on something that holds your interest to the point that the rest of the world fades into the background. This can happen randomly with mundane tasks and often it is easier to maintain your focus on tasks that are enjoyable or interesting to you.
When performing any sustained task, you must succeed on a DC 8 + (IE) Constitution saving throw. Failure indicates that you’ve been distracted — all related ability checks take (IE) × twenty percent times as long to complete. While distracted, you have a +(IE) on passive Wisdom (Perception). On success, you become hyperfocused and have advantage on all related ability checks. While hyperfocused, you have a −(IE) penalty on passive Wisdom (Perception).
When anticipating an important upcoming event, you must succeed on a DC 6 + (IE) Constitution saving throw. Failure indicates that you’re distracted by that event as above until it begins.
A cup of coffee, black tea, or another stimulant reduces the IE by 1 for 1 hour but then increases by 1 IE for 1 hour after it wears off. An ally using their action to help focus gives advantage on saving throws to maintain concentration. A fidget gives you a +1 on all saving throws associated with concentration or attention while using it. Keeping a checklist journal and reviewing it during rests can help organize tasks.
Anhedonia
August 3, 2022
You are unable to experience pleasure from social interactions and relationships (50%) or tactile stimuli (50%).
Social. You have resistance to being charmed and a +(IE) bonus against other forms of enchantment magic but a −(IE) penalty on Charisma (Performance) checks.
Physical. You have resistance to effects that cause euphoria but a −(IE) penalty on Charisma (Performance) checks and cannot receive the benefit of Bardic Inspiration.
Assistance involves compassionate patience by trustworthy allies who acknowledge your experience.
Amplified Emotion
August 3, 2022
You experience emotions strongly and deeply across the emotional spectrum. Because they come quickly, often without warning, you cannot prepare yourself for them and you react instinctively with little or no control.
Enjoyable Emotions. You experience 1d6 + 2 of the following in excess of typical experience: excitable, energetic, euphoric, needing less sleep, unusually talkative, racing thoughts, distractible, risk-seeking. During this time, you have a −(IE) penalty on Wisdom (Perception) checks and must succeed on a Constitution saving throw with a −(IE) penalty to maintain concentration on spells regardless of stimuli, but you need only half the necessary time for a short or long rest, and you gain + (IE) on initiative rolls.
Uncomfortable Emotions. If you are a barbarian, anytime you experience an upsetting situation, no matter how minor, you must succeed on a DC 10 + (IE) Wisdom saving throw or begin to Rage involuntarily, using up one of your daily Rages. If not a barbarian, when encountering a stressful situation, you must succeed on a DC 10 + (IE) Wisdom saving throw or become overwhelmed by fear or anger. Failure on the saving throw gives you a −(IE) penalty on all ability checks that round, and this continues each round until you succeed. You have a +(IE) bonus to Charisma (Intimidation) checks but a −(IE) penalty on Charisma (Persuasion) checks.
If an ally uses their action to help you calm down, you have advantage on the Wisdom saving throw to control your emotions.
Magical Assistance
The Calm Emotions spell can counteract this trait for the duration, but immediately after the spell ends, the target must succeed on the Wisdom saving throw as noted, even if the stressful stimulus is gone.
Alleviation Behavior
August 3, 2022
If you or someone you care about struggles with addiction in real life, call SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 in the USA or Text HELP to 55753 or call the National Problem Gambling Helpline (800) 522-4700. If you are outside the USA, opencounseling.com offers hotlines in other countries.
Your mind or body craves a substance or behavior that causes a compulsive pursuit of its associated reward in spite of consequences. This desire causes anxiety that can be alleviated through certain substances, actions, or patterns, but these responses reinforce the anxiety overall and create a cumulative dependence on the behavior. Choose or roll on the following table, or choose a different stimulus. When you encounter the stimulus or an opportunity to follow your compulsion, you must succeed on a DC 8 + (IE) Wisdom saving throw or follow your compulsion, repeating the saving throw every (IE) minute(s) until successful.
Every time you follow the compulsion, you must make a DC 5 + (IE) Constitution saving throw. On failure, the IE increases by one.
Aggression. You react disproportionately aggressively to situations with little or no thought to consequences. Use the Alleviation Behavior mechanics above with stress as the stimulus and reacting violently as the behavior. If you are a barbarian, if you fail your Wisdom check, you begin to Rage involuntarily, using up one of your daily Rages. You have a +(IE) bonus to Charisma (Intimidation) checks but a −(IE) penalty on Charisma (Persuasion) checks. If you have multiple traits, you may choose Baseless Emotion (Irritability) as one of them.
Body-Focused Repetitive Behavior. You feel a need to pick at, pull, bite, and/or eat parts of your own body, including your skin, nails, nose, or hair. You must succeed on a DC 8 + (IE) Wisdom check to resist this behavior. Depending on the specific behavior, if it affects your appearance due to visible effects, especially to your hair or face, when people who don't know you see you, they usually only see your hair or face. This gives you +(IE) to Dexterity (Sleight of Hand) checks but −(IE) (up to −4) to disguise checks or Dexterity (Stealth) checks to blend into a crowd as well as a −(IE) penalty on Charisma (Persuasion) checks due to many people’s discomfort around those with unexpected appearances. If you have behaviors that damage your skin, you must succeed on a DC 5 + (IE) Constitution saving throw every day of occurrence or develop Infection. (Note: This is not the same as self-harm. BFRB focuses on the behavior, and the harm it may cause is a consequence of the behavior. It is a form of grooming that continues to the point of harm. Self-harm (non-suicidal self-injury) specifically intends to cause harm to the body.)
Cleanliness. You experience discomfort due to exposure or perceived exposure to unhealthy substances, including dirt, toxic substances, body fluids, and sick people. When you believe you have encountered these contaminants, you must succeed on a DC 8 + (IE) Wisdom saving throw or experience a −(IE) penalty on all ability checks until the stimulus is removed, and you use (IE) actions to wash the affected area or, in the case of an airborne contaminant, washing all exposed skin.
Exercising. You have an obsession with physical fitness and exercise to the point of physical harm. Whenever stopping for a rest, you feel compelled to exercise instead of resting and must succeed in a DC 8 + (IE) Wisdom check to avoid doing so. You have a +1 to all Strength ability checks, but a −(IE) penalty on all Constitution saving throws due to your approach to exercise. If you have multiple traits, you may choose any Eating Disruption as one of them.
Gambling. You have an obsession with games of chance with financial or other stakes to the point of compromising your own wellbeing or relationships. When you don’t have access to a casino or other organized game, you will attempt to make bets with those around you based on your environment or circumstances, regardless of what resources you can afford to lose or the odds against you. If you have multiple traits, you may choose Attention Difference, Baseless Emotion, Amplified Emotion, or Emotion Fluctuation as one or more of them.
Harm. You have unwanted thoughts about harming others and fear that you will follow through on them or already have, so you take measures to avoid the behaviors you fear. The stimulus for this Obsessive Thought can be any stressful situation or no stimulus but the thoughts themselves, determined by the trait’s Frequency. If you fail your Wisdom check, your actions may include hiding or discarding weapons and other dangerous objects, avoiding stories of violent adventures, researching violent criminals to avoid becoming like them, frequently questioning yourself and others about your nature, retracing your steps to make sure you haven’t harmed someone unknowingly, or acting as meek as possible to avoid confrontation.
Hoarding. You feel a deep need to collect or keep certain items that others would consider useless or excessive for fear of harm to yourself or someone else if you don’t. You notice details and over value items intrinsically that others consider disposable. When you buy equipment, you must succeed on a DC 8 + (IE) Wisdom saving throw or purchase 1d4 extra, and when you use a consumable item with a container or acquire an item to replace something you already own, you must succeed on a DC 8 + (IE) Wisdom saving throw or feel compelled to retain the container or previous item indefinitely. Note that the item need not be carried on your person if you have a storage location that you consider safe.
Hyperawareness. You have a constant awareness and thoughts about a part or function of your body such as a mole, how your clothes feel, blinking, or swallowing. This can lead to compulsive behaviors to avoid the thoughts, such as self-checking on the feeling, trying to distract yourself with other thoughts, or reassurance-seeking. You have a −(IE) penalty on Constitution saving throws to maintain concentration and your passive Wisdom (Perception) due to this distracted focus.
Kleptomania. You feel the recurrent urge to steal things you don’t need or that have little value. The urge focuses on the act itself, not keeping the item stolen. You have a −(IE) penalty on Dexterity (Sleight of Hand) checks due to the obsessive nature of your stealing. If you have multiple traits, you may choose a Personality Difference, Baseless Emotion, Amplified Emotion, or Emotion Fluctuation as one or more of them.
Magic. You feel the need to cast spells or use other magic to perform tasks that would not require it, using up spell slots, item charges, and consumable magic items as a first choice given any task. This may lead you to prepare spells that you’re sure to be able to use even when other spells, though more useful, are slightly less likely to be needed. You also make choices that prioritize magic as an end instead of a means to an end, like spending money on new spells or scrolls whenever you get the chance, regardless of whether you can afford it.
Material Order. You feel a need to keep the objects in your environment organized in a specific pattern, grouped by category, or arranged symmetrically, and worry about negative consequences if they’re not. When encountering disordered objects (GM and player should discuss applicable stimuli), you must succeed on a DC 8 + (IE) Wisdom saving throw or experience a −(IE) penalty on all ability checks until the stimulus is removed or you use an action to arrange the disordered objects. You have a +(IE) bonus to all Wisdom (Perception) related to noticing pattern irregularities.
Moral Scrupulosity. You have obsessive thoughts about living up to a personal or religious moral standard and worry about how the slightest failure or immoral thought reflects on you. This leads to excessive praying, confessing, Reassurance Seeking, repetitive religious rituals, excessive altruism, inability to act due to struggling over the most ethical choice, and avoiding situations that you believe to be sources of temptation. You have a +(IE) bonus to Intelligence (Religion) checks specifically related to moral standards and rituals but a −(IE) penalty on initiative rolls due to indecision.
Perfectionism. You feel the need for certain experiences, environmental features, or actions to be just right. This can manifest in your grooming, clothing, writing, rituals, responses to décor, or other stimuli. If you fail your Wisdom check, you must repeat your actions or adjust your environment to achieve symmetry, repeating the Wisdom check after each attempt until you succeed on the check. You have a +(IE) bonus to passive Wisdom (Perception) to notice pattern or other detail irregularities, but when you notice, it triggers the compulsive action and required Wisdom check.
Pyromania. You have a fascination with setting or seeing fires to the point of being harmful. This compulsion happens every 1d100 ÷ (IE) days before experiencing withdrawal traits. When preparing spells, you must succeed on a DC 10 + (IE) Wisdom saving throw or choose fire-based spells over potentially more useful ones. If you have multiple traits, you may choose Baseless Emotion, Amplified Emotion, or Emotion Fluctuation as one or more of them.
Reassurance Seeking. Caused by any number of fears, Phobias, or Obsessive Thoughts, you need constant reassurance of a particular fear or group of fears, which leads to compulsive checking, either to reassure yourself or to ask others repeatedly for reassurance. You have a −(IE) penalty on saving throws against being charmed, but because you’re so meticulous, you have a +(IE) bonus to Intelligence (Investigation) checks, although any check takes (IE) times as long due to repeated attempts to verify.
Ritual Order. You feel a need to keep your actions organized in a specific pattern, ritual, or arranged symmetry and worry about negative consequences if they’re not. When beginning an action with specific steps, you must succeed on a DC 8 + (IE) Wisdom saving throw or experience a −(IE) penalty on all ability checks until you use a bonus action to finish the ritual. Spells with somatic components may need to be modified to work within your comfort range, requiring a day for every hour normally needed to inscribe into your spellbook and double the cost due to experimentation materials. Spells not reformulated accordingly require the above Wisdom check when performed.
Sensory Stimulation. You feel compelled to experience a category of stimuli such as visual, musical, or tactile. The player and GM should work together to determine the type of sensory input and how you typically express the compulsion and what its typical negative effects are.
Shapeshifting. You feel compelled to magically change your shape by whatever means you can find, whether by using magic on yourself or having someone do so for you. When preparing spells, you must succeed on a DC 10 + (IE) Wisdom saving throw or choose spells that alter your shape or appearances over potentially more useful ones. If you have multiple traits, you may choose Baseless Emotion, Amplified Emotion, Emotion Fluctuation, or Personality Difference (Loss of Self) as one or more of them.
Shopping. You feel compelled to spend money, whether or not you can afford it. You obsessively think about what your next purchase will be and use shopping to manage uncomfortable emotions. When haggling over a price, you have a −(IE) penalty on Charisma (Persuasion) checks due to your obsession with acquiring the item.
Spiritual Obsession. You have an obsession with religion beyond usual expectations. You become focused on fulfilling rules and worship to the detriment of your responsibilities, financial well-being, and relationships, needing religious experiences or rituals for emotional stability. If you have multiple traits, you may choose Baseless Emotion, Amplified Emotion, or Emotion Fluctuation as one or more of them.
Substance. You use a medicinal substance or alcohol outside of its recommended use or quantity. When you use the substance, if you continue to fail your Wisdom saving throw, you become Intoxicated until being incapacitated or according to the effects of the substance. If you go without the stimulus for 1d6 − (IE) days, you experience the following, adding one per 1d4 days in order up to (IE) withdrawal experiences: Baseless Emotion (Irritability), Hand Tremor, Vertigo, Hallucinations unless you succeed each day on a DC 10 + (IE) Constitution saving throw for (IE)d4 days. Once the withdrawal period ends, you are “recovering.”
Workaholism. You have an obsession with your work, focusing on it at the expense of other responsibilities and relationships. While player characters spend a lot of time focused on their class, a workaholic specifically focuses on the abilities and features associated with their class at the expense of other responsibilities. You have a +1 bonus to checks on skills for which your class gives you a bonus but a −(IE) penalty on all other ability checks.
Real-world Examples
Addiction, Intermittent Explosive Disorder, Autism, Obsessive-Compulsive Disorder, Trichotillomania, Dermatillomania, Onychophagia, Trichotemnomania, Dermatophagia, Rhinotillexomania, Trichophagia, Onychotillomania (Note that, while we grouped addictions and compulsions, which often co-occur, compulsions seek specific rituals to cope with reality, while addictions seek an escape from reality.)
Assistive Options
Many of these stimuli could lead to either addictions or compulsions, depending on the subconscious mental process motivating it, and the assistance varies. We provide the information below as suggestions for those who wish to explore a recovery narrative, but as with all suggestions, this is not real-world medical advice, and any of these real-world experiences should be managed through a recovery program or licensed professional.
Addiction
The most important assistance with addiction is support from people who care about you who are willing to lovingly confront you and encourage you to replace the addiction with non-destructive behavior. If such people are with you and use their action to help you, you receive a +1 bonus per assisting person (up to +5) to your rolls to resist, including the Wisdom check to recognize and acknowledge the addiction.
Before you can begin recovering, you must first recognize the problems caused by the addiction. Every time you experience a negative consequence of an addictive behavior, you must succeed on a DC 15 + (IE) Wisdom check to recognize and acknowledge the addiction. The addiction is never cured, but when you encounter the stimulus, you must succeed on a DC 5 Constitution ability check to avoid following the compulsion.
Compulsion
For compulsive behavior, with professional assistance, gradual increased exposure and proximity to the compulsive stimulus can help reduce the compulsive reaction over time. The assisting cleric, druid, or physician must succeed on a DC 8 + (IE) Wisdom (Medicine) check to offer proper assistance. If the assistant fails this check or it’s made without an assistant, you make your Wisdom checks with disadvantage. You (the character) will not know that the assistance succeeded, but if they fail, you may notice over time that it’s not helping and seek a different assistant.
When attempting to reduce your compulsive reaction, begin with a representation such as a painting or imagining the stimulus and work up from there to maximum exposure with the real version. The player and GM should develop a strategy of eight to ten steps and may attempt this once per day. For the first step, you must succeed on a DC 8 + (IE) Wisdom check for three consecutive attempts. The days need not be consecutive. Once accomplishing that step, the DC increases by 1 and requires three consecutive successful attempts, repeating the process until every step is successfully completed. If you have a traumatic experience, you must succeed on an additional Wisdom saving throw equal to your current step roll or lose one step, even if you’ve completed all steps.
Animated Hand
August 3, 2022
One of your arms (the nondominant one 90 percent of the time — choose or roll 1d10 to determine) acts as if it has a mind of its own, not responding to your will and doing seemingly typical acts but inappropriately, such as picking up and moving objects, unbuttoning a shirt while you rebutton it with your other hand, knocking objects out of your hand, groping your body, etc. While out of your control, you cannot use it for any intended purposes. You must also make a Constitution saving throw every round to maintain spells. Spells with somatic components usually need to be modified to work within your physical range, requiring a day for every hour normally needed to inscribe into your spellbook and double the cost due to experimentation materials. In ten percent of cases, when the hand begins acting on its own, you must succeed on a DC 5 + (IE) Charisma saving throw, failure resulting in the hand being hostile toward you, attempting to choke or grapple you. In this case, you can resist the grappling as usual by succeeding on a contested Strength check against yourself. The GM should determine the hand’s actions, which may also require a contested Dexterity check if trying to knock something out of your hand.
Real-world Examples
Alien Hand Syndrome caused by brain tumors, aneurysms, stroke, neurodegenerative disease, or trauma.
Assistive Options
Binding the hand will keep it from causing damage but will eliminate being able to use it when it’s functioning normally. Allies assisting against attacks give you advantage on the checks.
Magical Assistance
Charm Person and related spells can affect the hand to bring it under control, although if you have Fey Ancestry or other resistance to being charmed, the hand will also have this resistance.
As with all rules in this compendium, these game mechanics are simply suggestions to begin the discussion on how to safely include these in your games. Mental health issues are complex and diverse, so the distinction between neurological traits and mental traits in this book is artificial and purely for game design. We've included these mechanics for the sake of representation and education, but everyone’s experience is different, so the player and game master should start with the rules for any given trait as suggestions, and then discuss how they would like to portray these traits at their table — collaboration is key to safe play. Even though this is a book of game mechanics, “I want to roleplay the trait without modifiers or other rules” is a valid way to play these traits.
Some traits also include a path to recovery. If a trait does not include such a path in its entry, that doesn’t mean recovery is impossible — you may find inspiration from the assistive options listed under each entry to play a recovery narrative in your game. Note that recovery is an often-complicated process that cannot be adequately portrayed through a few dice rolls, and the recovery mechanics are given here to communicate hope to those affected by these experiences.
Missing from nearly all of these descriptions is one of the most effective assistive options: a qualified therapist. We didn’t include that in this book due to the complexity of the therapy process, but note the suggestions throughout this section if one of these affects you in real life. We want everyone to get the help they need to fight the monsters in their lives. The Geek Therapeutics network may be a good match for many of our readers, depending on your location, insurance, and specific needs. Otherwise, check your local listings for providers.
Pervasive Hunger
August 3, 2022
You are always hungry and have difficulty gaining weight. You must eat an additional (IE) days’ worth of food to maintain your weight or experience one of the following after ten days of not eating enough (1d4 to determine, IE 1): Skeletal Flexibility, Hyperelasticity, Fatigue, or Immunocompromised until one day after eating enough to compensate.
Real-world Examples
Hyperthyroidism, Diabetes, Inflammatory Bowel Disease, Congenital Central Hypoventilation Syndrome
Assistive Options
Besides eating more often, high calorie foods, including grains, oils, and nuts, can help achieve the needed calorie intake.
You have difficulty controlling when or how your body voids your bladder or colon. When you feel the urge, you have 1d4 ÷ (IE) minutes, after which you must succeed on a DC 8 + (IE) Strength saving throw to prevent the release every round, the DC increasing +1 cumulatively per round. If this is a triggered trait, typical triggers include active movement (actions requiring a physical ability check), coughing and sneezing, or taking damage.
Scheduling regular “timed voidings” and urinating before physical activities can keep your bladder empty enough to avoid leakage.
Food Intolerance
August 3, 2022
Your body is unable to digest certain foods or ingredients, causing (IE) of the following traits. This trait Frequency is always triggered. Because you’re used to being careful with your diet, you have a +(IE) bonus to Intelligence (Investigation) checks to detect your stimulus or similar foods.
Fermentable Oligosaccharides, Disaccharides and Monosaccharides and Polyols (FODMAPs)
5
Fructose
6
Gluten
7
Histamine
8
Salicylates
9
Sulfites
10
Yeast
Real-world Examples
Food Intolerance
Assistive Options
The easiest way to avoid these traits is to avoid the associated foods and have support from allies in navigating avoiding these foods when eating out or shopping for rations.
Diarrhea
August 3, 2022
You have loose and frequent bowel movements. You need to void your bowels every 1d8 ÷ (IE) hours (The GM can reroll after each time.), and when you feel the urge, you have 1d4 ÷ (IE) minutes, after which you must succeed on a DC 8 + (IE) Strength saving throw to prevent the release every round, the DC increasing +1 cumulatively per round. You must drink (IE) extra skins of water per day or experience Dehydration. Once per day, you must also succeed on a DC 8 + (IE) Constitution saving throw or experience IE 1 abdominal Cramps or Nausea.
A careful diet of juices and broths, rice water, low-fiber and low-fat foods like rice, bread, eggs, and poultry and avoiding caffeine, alcohol, dairy, and spicy foods the day before will reduce the IE by 1 (minimum 1).
