If your ancestry usually has a tail, yours is missing (IE 1) or (IE) times as long as is typical for someone of your height and ancestry. If your ancestry does not usually have a tail, you have one with a length of 50 + (IE) × 20% of your height. The tail is not prehensile but does help you balance, giving you a +(IE) bonus to balance-related Dexterity checks and saving throws. This gives you +(IE) to Dexterity (Sleight of Hand) checks but −(IE) to Charisma (Persuasion) checks with people who don’t know you due to many people’s discomfort around those with unexpected appearances, and some may mistake you for a lycanthrope or other shapeshifter.

Real-world Examples

This is a fantasy trait with no real-world analog.

Assistive Options

Loose-fitting clothing may allow you to hide the tail from casual observation.

Magical Assistance

A Seeming spell or similar magical effect is necessary to hide the tail.

You have trouble swallowing solids (50 percent) or liquids (50 percent).

If solids, when you eat, you need your food ground up or cut very small, or you must succeed on a DC 8 + (IE) Constitution saving throw or begin choking.

If liquids, you need to add a thickener like corn starch to anything you drink so you don’t aspirate or get Pneumonia. This takes 1 action to add it and mix, and drinking a thickened potion takes 2 rounds. If you drink a liquid without thickening, you must succeed on a DC 8 + (IE) Constitution saving throw or begin choking, and every time you fail, you must succeed on an additional DC 8 + (IE) Constitution saving throw or contract Pneumonia.

Real-world Examples

Achalasia, Esophageal Stricture, Scleroderma, Multiple Sclerosis, Muscular Dystrophy, Parkinson’s Disease

Assistive Options

Assistance comes in the form of the aforementioned manipulation of food to make it safe to consume.

Magical Assistance

The Goodberry spell can be modified to produce a liquid form.

Your spine or neck/back muscles are stiff, resulting in pain when moved sharply or quickly. Whenever anything jarring happens to your body (e.g., making a Strength or Dexterity saving throw, taking damage), you need to succeed on a DC 8 + (IE) × 2 Constitution saving throw. Failure results in taking one level of exhaustion until you take a short rest. This stiffness limits your head and neck movement, so you have a −(IE) penalty on all Wisdom (Perception) checks involving vision against Dexterity (Stealth).

Real-world Examples

Spinal Fusion, Arthritis, Herniated Disc, Sciatica

Assistive Options

Applied heat or cold may help, as can a 1-minute massage. A character with back or neck stiffness will likely have determined what works for them. The player and GM should decide what works effectively, and using such a method will reduce the IE by 1 for 1d6 hours. Spending (IE) hours per day (15 minutes at a time spread throughout the day) stretching the stiff muscles will reduce the IE by 1 until the next stretching session is due. A back brace gives a +2 bonus to the Constitution saving throw from jarring pain. Spending one hour swimming or bathing in warm flowing water will reduce the IE by 1 for 2d6 hours.

Magical Assistance

Applying magical healing specifically to the point of pain without restoring hp will reduce the IE by 2 for 1d4 hours.

My spine doesn’t quite align, and everything is squinty, but don’t underestimate me. Although everything from the ribcage down is 10% dysfunctional, everything above works, and it’s the 90% functional that gets me into trouble!

– Dorian

Your spine has openings, exposing the neural tissue within, leaving you vulnerable to a variety of conditions and, at IE 4, Infection. You have −(IE) to Constitution saving throws against disease. You have (IE) of these related traits: Spine Difference, Muscle Control & Gait Difference, Body Rash, Sleep Disruptions, Diverse Face Shape, Skeletal Flexibility, Head and Neck Pain, or Incontinence. You have a heightened awareness of your own body and can predict internal changes. This gives you a +(IE) bonus to saving throws against magic that alters your body shape or internal function such as the Polymorph spell or Werewolf, and when recurring Pain or other physical traits manifest, a successful DC 10 passive Wisdom (Perception) check will alert you to its onset 1d20 minutes in advance.

Real-world Examples

Spina Bifida

Assistive Options

Spinal surgery is too dangerous in most fantasy world settings, so no mundane options help, although many of the related traits benefit from mobility aids and other options.

Magical Assistance

Magic that helps cure disease can help against frequent infections. Consult the related traits for additional assistance.

You have ridges, plates, or spikes running the entire length of your spine, each (IE) inches long. You can use these to make an unarmed attack causing 1d(IE) damage, either piercing or slashing damage, depending on the shape of the ridge. You cannot fit into magical armor, and a normal suit of armor costs +20 percent to allow openings that do not reduce the armor’s integrity.

Real-world Examples

This is a fantasy trait with no real-world analog.

Assistive Options

These cannot be trimmed as they have blood vessels running through them. No mundane assistive options exist.

Magical Assistance

A Seeming spell or similar magical effect is necessary to mask the protrusions.

You experience chronic pain in your head or neck. Any action that requires concentration (e.g., maintaining a spell) requires a successful DC 10 + (IE) Constitution saving throw per round to maintain concentration. In the presence of bright light or loud noise, you make the roll with disadvantage. Because you’re used to managing pain, even though this doesn’t reduce the experience of pain, you have a +(IE) bonus to saving throws against psychic damage.

Real-world Examples

Hemicrania Continua, Migraines, Cervicogenic Headaches, Postural Orthostatic Tachycardia Syndrome

Assistive Options

Laying down or avoiding bright light or loud noises can help you feel better but does not eliminate the game mechanic.

Magical Assistance

A healing spell can target the head or neck and reduce the IE by 2 for 1 hour instead of regaining hp.

Your neck is (IE) feet longer than the typical range for your ancestry. This allows you to see over some obstacles, but because the neck and spine are vulnerable, you take (IE) extra damage from bludgeoning and slashing damage. You also have a −(IE) penalty to attempts at disguise or blending into a crowd.

Real-world Examples

This is a fantasy trait and has no real-world analog, although the Kayan people of Myanmar wear heavy brass rings or coils that, from childhood onward, push the shoulders down, giving the appearance of a long neck, and can be uncomfortable when removed.

Assistive Options

A custom cloak can attempt to disguise this condition with an opposed Charisma (Deception) check made with disadvantage and a −(IE) penalty.

Magical Assistance

Spells like Seeming can attempt to temporarily mask this condition, but it does not eliminate the damage penalties.

You have a tumor or lump on your neck with a diameter of (IE) inches. This causes difficulty breathing and swallowing, causing a −(IE) on all Constitution checks involving physical endurance.

Real-world Examples

Tumor, Goiter, Cyst, Hodgkin’s disease

Assistive Options

No mundane assistance helps with this, and surgery to remove the lump, because of the vital blood vessels in the neck, requires a successful DC 20 + (IE) Wisdom (Medicine) check, failure resulting in death.

Magical Assistance

A Minor Illusion spell can temporarily hide the visibility of the lump but not its physical effects.

Your spine curves, causing you difficulty and pain to straighten it directly upright, if at all. This gives you a −(IE) penalty on all Dexterity (Acrobatics) checks and Strength (Athletics) checks to jump. (Roll 1d12 for the direction of the curve, 12 being straight forward, then clockwise around.)

Real-world Examples

Scoliosis, Kyphosis, Lordosis

Assistive Options

A brace is helpful to prevent curvature from getting worse, although braces can be painful, and some choose to have their back assume whatever position it would naturally move into.