You are unable to perform certain actions, even though you’re physically able to do so. You know how to do them and want to do them, but your brain will not allow you to do so. Roll (IE) times on the following table. With enough effort, you might be able to perform the task in question, but each step requires a successful DC 15 Constitution check. Any magic effect that would force you to do something beyond your ability will automatically fail.

• Conceptual. You are unable to perform tasks that involve how tools work. You have a −(IE) × 2 on all checks to use tools or weapons.
• Buccofacial. You are unable to perform facial and lip movements such as whistling, winking, coughing, etc. on command. The player and GM choose (IE) actions that you’re unable to perform and develop associated complications. (e.g., inability to cough will require DC 5 + (IE) Constitution saving throws when drinking liquids to avoid Pneumonia, an inability to blink will require eye drops to hydrate eyes, etc.)
• Limb-Kinetic (Arm). You are unable to use fingers or arms to perform certain tasks such as using tools or weapons, snapping fingers, opening a bottle, etc. The GM and player should choose (IE) actions that cannot be done.
• Limb-Kinetic (Leg). You are unable to use your legs or feet to perform certain tasks such as tapping your foot, kicking, jumping, etc. The GM and player should choose (IE) actions that cannot be done.
• Ideomotor. You are unable to mimic limb or head movements performed or suggested by others. This makes learning new skills or level advancement challenging, as you can’t follow directions to learn techniques but must learn them on your own. When gaining or increasing a feat or proficiency based on Strength or Dexterity, you need an additional (IE)d20 days to gain the bonus.
• Ideational. You’re unable to plan a series of movements. You need constant coaching to know what to do next.
• Verbal. You are unable to verbally communicate some or all words. You can’t get your mouth to form the words without extreme difficulty. If you need to say something, you must succeed on a DC 10 + (IE) × 2 Constitution check per word unless only using the limited vocabulary available to you. You cannot use spell scrolls, and spells with a verbal component require you to modify their vocabulary or add additional somatic components if possible. The complexity of this change requires one day for every hour usually needed to inscribe it into your spellbook and twice the cost due to additional experimentation needed.
• Constructional. You have great difficulty copying, drawing, or constructing basic diagrams or figures. If you need to communicate via writing or drawing, you must succeed on a DC 10 + (IE) × 2 Intelligence check to convey the information you’re trying to communicate. You need assistance writing spells into your spellbook from another wizard who is high enough level to be able to cast the spell you’re attempting to scribe, requiring a successful DC 8 + (IE) Charisma check to communicate it successfully. If you fail the check, the inscription fails, and you need to start over, forfeiting the time and materials from the first attempt.
• Oculomotor. You have difficulty moving your eyes to focus on a desired object or direction. You have a penalty of −(IE) on all Wisdom (Perception) checks that depend on sight. You have a −(IE × 2) penalty on all ranged attack rolls. It takes you 1 + (IE) times as long to prepare a wizard spell from your spellbook due to the challenge of focusing your eyes on the page of the spellbook.

Real-world Examples

Corticobasal Ganglionic Degeneration, Balint Syndrome, Autism, Sensory Processing Disorder

Assistive Options

Most of these benefit from a dedicated assistant who can talk you through what you need to do, reducing the penalty by 1.

You are unable to reproduce one or more sensory experiences in your mind. Because of this, you’re unable to remember associated sensory experiences well or recognize people or objects that are less familiar. You can remember the feeling associated with experiences, places, and people. As a result, must succeed on a DC 15 Intelligence roll to accurately describe something you’ve perceived with that sense but have a +(IE) to describe it with a different sense. You also have a −(IE) penalty on Charisma (Performance) checks related to that sense due to challenges reproducing the sensory information, or you can forgo the penalty by taking 1 + (IE) × the usual amount of time to create it. But because illusion spells depend on mental perception or conjuring a mental depiction, you have a +(IE) bonus to all saving throws against illusion magic. If you have multiple traits, you may choose additional Aphantasia senses or Agnosia as one or more of them.

Real-world Examples

Aphantasia

Assistive Options

Assistance is learning to adjust how to remember, so when hearing a description, the listener imagines the associated feelings of such an experience, for example.

You are unable to recognize your own medical condition, regardless of evidence or explanation. This trait is always accompanied by at least one more trait. Regardless of the trait(s) you have, you will act as if you did not have one or more of them, (50 percent chance to recognize each of them, at least one not recognized) regardless of the consequences. You may deny the condition, explain it away, or change the subject. This is not stubbornness — your mind is incapable of recognizing the condition.

Real-world Examples

Anosognosia

Assistive Options

What this trait needs most is patience and understanding that it’s a condition, not an intention.

Magical Assistance

Any assistance will need to address the traits. The challenge is convincing the user that it’s needed.

Your tendons and joints are pliable, making basic tasks like sitting upright or moving painful. You take (IE) × 10 percent less damage from all bludgeoning damage. Your movement rate is reduced by (IE) × 10 percent, and you have a +(IE) bonus on all saving throws against bludgeoning, force, or thunder damage, but when you take bludgeoning, force, or thunder damage, you must succeed on a Dexterity saving throw to avoid falling prone as your joints buckle. The DC equals 8 + (IE) or half the damage you take, whichever number is higher. If you take damage from multiple sources, such as a club and a ram, you make a separate saving throw for each source of damage. You also can benefit from a +(IE) bonus to all rolls against being restrained or grappled, although this also causes (IE) psychic damage if you use this bonus due to the pain. You’ve learned a lot about your own bones and joints, so you have a +(IE) bonus to Wisdom (Medicine) checks related to bones and joints. If you have multiple traits, you may choose Dislocation and Hyperelasticity as one or more of them.

Real-world Examples

Ehlers-Danlos Syndrome, Joint Hypermobility Syndrome, Hypophosphatasia, Osteoporosis

Assistive Options

Braces over your limbs and joints can give you a +1 to the Dexterity saving throws to avoid falling prone but also cause a −1 penalty on all Dexterity (Acrobatics) checks.

1d4 areas of your body are (IE) × 20 percent smaller than their typical proportion for your ancestry. Choose or roll on the following table. This smaller stature allows you to hide more easily, giving you a +(IE) bonus on Dexterity (Stealth) checks.

• Trunk. Because most of your internal organs are in your trunk, some are underdeveloped, causing a −(IE) penalty on Constitution saving throws.
• Arms & Hands. You can’t use 2-handed weapons effectively. Because you have less leverage, you have a −(IE) penalty on contested Strength checks.
• Legs & Feet. Your movement speed is reduced by (IE) × 5 feet. You also have a −(IE) penalty on Dexterity checks to balance.
• Arms. Your arms are shorter, but your hands are average size. Because you have less leverage, you have a −(IE) penalty on contested Strength checks.
• Legs. Your legs are shorter, but your feet are average size. Your movement speed is reduced by (IE) × 5 feet.
• Head. The reduced size of your head causes (IE) other traits according to the following table, each with its own IE.
  

  d6	Trait
  1	Seizures
  2	Intellectual Disability
  3	−(IE) on Dexterity checks to balance
  4	Swallowing Difficulties
  5	Hearing Loss
  6	Refractory Issues

Real-world Examples

Achondroplasia, Turner Syndrome, Growth Hormone Deficiency, Spondyloepiphyseal Dysplasia Congenita, Microcephaly

Assistive Options

Wheelchairs and other mobility devices can be helpful to assist with some of the penalties associated with these traits.

Magical Assistance

Magic items that give magical strength such as a Girdle of Giant Strength can assist with the Strength penalties of some of these.

(IE) of your joints dislocate(s) easily. Whenever you make a Strength ability check or attack roll or melee attack, stand or walk for 20 ÷ (IE) minutes, walk on difficult terrain or stairs for 10 ÷ (IE) minutes, or take bludgeoning, force, or thunder damage, you must succeed on a DC 8 + (IE) Strength saving throw. If these rolls or damage happen multiple times in consecutive rounds, or for each 10 minutes of difficult standing or walking, the IE increases by 1 until you rest for 1 round per added IE. On failure, a joint subluxates (partially dislocates). If you fail by more than 5, the joint dislocates. Use the following table to determine which joint.

After a subluxation, you experience a −1 penalty on all rolls with that joint until you take a long rest. After a dislocation, you must succeed on a subsequent DC 8 Strength check to put the joint back together, using 1 action. (You can receive help resetting it.) On a successful attempt to reset it, you can use the limb, but you experience a −(IE) penalty on all rolls with that joint due to post-dislocation pain until you take a short rest. Following a long rest or getting up from being prone, you must succeed on a DC 8 + (IE) Strength saving throw or have another subluxation or dislocation as above from the way you were laying on the joint. If you have multiple traits, you may choose Pain, Skeletal Flexibility or Hyperelasticity as one or more of them.

Real-world Examples

Ehlers-Danlos Syndrome, Hypermobility Syndrome

Assistive Options

Wearing a brace can reduce the IE by 1 but causes a −1 penalty on Dexterity checks using that limb. Surgery (IE × 100 gp), requiring a successful DC (IE) + 10 Wisdom (Medicine) check, may prevent Dislocation, but it limits joint movement afterward, giving you a permanent −2 penalty on applicable Strength (Athletics) and Dexterity (Acrobatics) checks.

Magical Assistance

Healing magic specifically applied to the limb, once reset, can remove the penalty for the post-dislocation pain instead of restoring hit points.

(IE) areas of your body are not the shape typical for your ancestry—curved, rotated, bulbous, or otherwise different. Roll on the following table for the locations:

• Ribs. Your ribs are too small for your chest. You have trouble breathing as your ribs press on your lungs. Every minute of exertion, such as combat, a walking forced march, or climbing, you need to either succeed on a DC 5 + (IE) Constitution saving throw—increasing cumulatively by 1 every minute of exertion—or take one level of exhaustion until taking a short rest.
• Arm. Your arm bone curves or is underdeveloped such that you have a −(IE) penalty on all Strength checks and melee attack rolls that use your arms.
• Leg. Your leg bone curves or is underdeveloped such that you have a −(IE) penalty on all Strength checks and melee attack rolls that use your legs.

Real-world Examples

Paget’s Disease of Bone, Neurofibromatosis, Jeune Syndrome, Spondylocostal Dysplasia, Spondylothoracic Dysplasia, Phocomelia

Assistive Options

Depending on the nature of the malformation, a prosthetic might help reduce the penalty by 1 in some instances. For other manifestations, a wheelchair or other mobility device may help.

You have calcium deposits building up in your body. This results in (IE) × 10 percent of your body being covered in horn-like extrusions. You can use these deposits as an unarmed attack causing 2 (1d4) + Strength modifier piercing damage. You are unable to wear most armor without it being custom made, costing 200 percent + (IE) × 10 percent and taking 100 percent + (IE) × 10 percent time to smith. You have a −(IE) penalty on disguise attempts and a −(IE) penalty on Charisma (Persuasion) checks. Calcification occurs internally, too, which is usually harmless but could lead to painful complications. Every 28 days, roll 1d20. On a 1, you must succeed on a DC 5 Constitution saving throw. Each time this happens (regardless of the result of the saving throw), the DC increases by 1, and each time you fail the saving throw, the original roll increases by 1, making it more likely to happen in the future. On a failed saving throw, you experience internal pain, 2 (1d4) psychic damage, until you succeed on a daily Constitution saving throw of the same value as the one you failed.

Real-world Examples

Kidney Stones, Hypercalcemia, Osteophytes (In real life, calcification is purely internal. Its expression here is a fantasy exaggeration, and those wishing for a more realistic representation can use just the internal mechanics.)

Assistive Options

Drinking twice the usual amount of water every day gives a +1 bonus to Constitution saving throws against internal calcification complications.

Magical Assistance

Magical healing applied directly to the source of internal pain will heal that occurrence but not heal other damage.

Your bones grew more than normal (50 percent) or less than normal (50 percent).

If more, then your height is (IE) × 10 percent more than the typical maximum height for your ancestry. Because of the strain that this puts on your body, you have a −(IE) penalty on all Constitution checks, and clothing and armor usually costs an additional 100 percent + (IE) × 10 percent.

If less, your height is (IE) × 10 percent less than the typical minimum for your ancestry. The same hormonal deficiency that reduces growth also reduces some organ development, so you have a −(IE) penalty on Constitution saving throws.

Real-world Examples

Acromegaly, Gigantism, Growth Hormone Deficiency, Down Syndrome

Assistive Options

These traits have no mundane assistive devices. Some with these traits pose as those of other ancestries such as short humans as halflings, although halflings and those familiar with them notice the difference in body proportions.

Magical Assistance

The Enlarge/Reduce spell and items that duplicate its effects assist with the size difference but do not remove the Constitution penalties.