You have trouble organizing yourself, including your thoughts, your possessions, your emotions, your time, and your memory. You have trouble making decisions about what to do next to the point of being unable to act on a choice at all. You have a −(IE) penalty on all initiative rolls, and on an initiative roll of 1 or less (or a natural 1), you cannot use your action or bonus action for the first round due to indecision, but you can still use your reaction. In some cases, you may have trouble transitioning unexpectedly to a new task or changing plans. You have a −(IE) penalty on your passive Wisdom (Perception) to determine surprise, and if the plans for the day change, you must succeed on a DC 8 + (IE) Constitution saving throw or have disadvantage on all Wisdom and Charisma checks for (IE)d4 minutes while you mentally adapt to your new circumstances and plans. On any attempt to find something that you previously possessed, you have a −(IE) penalty on Wisdom (Perception) checks to find it. You have a −(IE) penalty on all reaction ability checks, saving throws, and attack rolls. Because you’re used to having to compensate for your decision-making, you have developed creativity and resilience, so once per day, when making a non-combat ability check, you can choose to do so with advantage. Multiple days in a row with high stress or demands can temporarily increase the IE. If you have multiple traits, you may choose Attention Difference, Amplified Emotion (Uncomfortable), Diminished Motivation, or Amnesia (Anterograde) as one or more of them.

Real-world Examples

Attention Deficit Hyperactivity Disorder, Dementia, Depression, Obsessive-Compulsive Disorder, Schizophrenia, Autism

Assistive Options

Planning ahead helps organize thoughts, breaking down the upcoming days into manageable chunks of time. The party should do what they can to develop strategies for the future. Any situation that has been anticipated and planned accordingly reduces IE by 1 for that situation as you implement strategies to keep track of everything.

Magical Assistance

When the Haste spell is used on you, you can choose whether to gain the usual benefits or instead to reduce your IE by 2. The Foresight spell can also be used in this way with its longer duration, but casters may be unwilling to use a ninth-level spell slot for this purpose. A Handy Haversack can help you organize some possessions (if that’s where you put them).

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.

You have trouble remembering events. Choose or roll on the following table.

• Anterograde Amnesia. You are unable to form new memories but recall your past until 1d100 × 30 days ago or after a specific story arc. Recalling new events, people, directions, or other details requires a successful DC 8 + (IE) × 2 check to remember general information or a higher DC for specific details. You can still sometimes learn procedures and routines. All Experience Points you earn are divided by (IE) + 1 or, if not using XP level advancement, when gaining or increasing a feat or proficiency, you need an additional (IE)d20 days to gain the bonus. It also takes you (IE) × 5 times as long to prepare spells. This form of memory loss has no Frequency. When charmed, you get an extra saving throw each round as you may forget your favorable impression of the source of the charm.
• Retrograde Amnesia. You have difficulty recalling memories before 1d100 × 30 days ago or before a specific story arc but have full memory of everything after that. You retain general knowledge and skills but may not remember how you learned. You’re more likely to remember episodes from your distant past than more recent memories. Recalling people or events from the most recent (IE) × 20 percent of your life requires a successful DC 10 + (IE) × 2 Intelligence check, and recalling earlier memories requires a successful DC 10 + (IE) Intelligence check. A successful check will recall general information, more details requiring a higher DC. This form of memory loss has no Frequency.

Sometimes life feels like a constant brain fog. But times spent sitting with friends telling stories are the golden moments of clarity I live for.

-Niles M

• Dissociative Fugue. You are confused about your identity or have formed a new one. You retain skills from your original identity but may try using skills you don’t have. For example, you may experience frustration as to why you can’t cast spells or why you can, believe your stealth skills are better than they are, etc. The GM and player should work together on the false identity, creating a random persona but retaining most or all previous abilities. (Try a random NPC or character class generator such as the one on dndbeyond.com or npcgenerator.com to get started.) This form of memory loss does have a Frequency, and recalling a single memory about your identity requires a successful DC 10 + (IE) × 2 Intelligence check while in a fugue state.
• Traumatic Amnesia. You have little or no memory of (IE) traumatic events from your past. Recalling a detail from one of those events requires a successful DC 15 + (IE) Intelligence check. Failure requires (IE) × 30 days or until after the next adventure or story arc for each event before making another attempt. When successfully recalling a traumatic memory, you may feel overcome while you come to terms with this recovered memory and must succeed on a DC 8 + (IE) Wisdom saving throw or take one level of exhaustion for 10 × (IE) minutes. This form of memory loss has no Frequency.

Real-world Examples

Korsakoff’s Syndrome, Dementia, Post-Traumatic Stress Disorder, Dissociative Amnesia, Encephalitis

Assistive Options

Written notes or journals can help keep track of memories. Friends and allies can help with recall, granting advantage on recall attempts even if the helper was not present for the episode in question.

Magical Assistance

Divination spells like Divination and Commune can help answer questions about the past that have been forgotten, but it does not recover the actual memory.

You experience mental fatigue that affects your memory, ability to concentrate and think clearly, and focus. You have a −(IE) penalty on concentration saving throws, and when you need to make an Intelligence check to remember something, you have a −(IE) penalty on the check unless you take 1 + (IE) times as long to think about it.

Real-world Examples

Autism, Attention Deficit Hyperactivity Disorder, Chronic Stress, Sleep Disorders, Menopause, Anemia, Depression, Diabetes, Sjögren Syndrome, Migraine, Dementia, Hypothyroidism, Lupus, Arthritis, Multiple Sclerosis, Dehydration, COVID-19

Assistive Options

Regular sleep and exercise and a balanced diet may help. A rest will relieve Brain Fog for 1d6 hours. Keeping a journal, calendar, task list, or other notes can compensate for memory challenges.

You have an altered sense of taste. Choose or roll on the following table.

Amplification. Your sense of taste is more sensitive than most. This gives you a +(IE) on Wisdom (Perception) checks involving taste but a −(IE) penalty on Constitution saving throws against taste and smell-related effects.

Disruption. Your sense of taste is less sensitive than most. This gives you a −(IE) penalty on Wisdom (Perception) checks involving taste but a +(IE) benefit on Constitution saving throws against taste and smell-related effects.

Discrimination Modification. You taste things differently than other people. Sour foods may taste sweet — mild, spicy. This gives you a −(IE) penalty on Wisdom (Perception) checks involving taste but a +(IE) benefit on Constitution saving throws against taste and smell-related effects. The player and GM should discuss the exact effect on you and any resulting changes to rolls.

Sensitivity. You are extremely sensitive to (IE) types of tastes. Roll on the following table for each type:

If you eat a food that even mildly fits into the corresponding taste category, you must succeed on a DC 5 + (IE) Constitution saving throw or become obsessed with finding another food or drink to cleanse and can do nothing else until then or until (IE) d20 minutes has passed, at which point your mouth has naturally washed out the flavor.

Real-world Examples

GI Disease, Parkinson’s Disease, Diabetes, Dementia

Assistive Options

Some people find it helpful to lick a food first to determine the taste. This will normally not trigger a strong reaction but give a sense of how it might affect you. Note that many cultures would find this behavior rude or strange.

Magical Assistance

The Prestidigitation spell can alter the flavor of food.