You have ongoing difficulty passing stool. Every three days, you must succeed on a DC 8 + (IE) Strength check during a rest to do so effectively or experience either IE 1 abdominal Cramps or Nausea until making a successful check, which can be attempted during every rest.

Real-world Examples

Hypothyroidism, Diabetes, Uremia, Hypercalcemia, Irritable Bowel Syndrome, Diverticular Disease, Spinal Cord Injury, Multiple Sclerosis, Parkinson’s Disease, Lazy Bowel Syndrome, Amyloidosis, Lupus, Scleroderma

Assistive Options

A steady diet of high-fiber, low fat foods for the entire three-day duration beforehand gives a +1 bonus to the Strength saving throw.

Your body has an itchy rash that covers (IE × 20 percent) of it. This can include discoloration, hives, blisters, lesions, pustules, scaling, peeling, and/or sores. Because of the itchy distraction, you must succeed on a DC 5 + (IE) Constitution saving throw to maintain concentration each round on an applicable spell. You must also succeed on a DC 5 + (IE) Constitution saving throw every day or develop Infection.

Real-world Examples

Rosacea, Impetigo, Ringworm, Dermatitis, Eczema, Psoriasis, Lupus, Cellulitis, Hand, Foot, And Mouth Disease

Assistive Options

A successful DC 8 + (IE) Wisdom (Medicine) check with proper application of oil and herbs will reduce the IE by 1 for 2d4 hours.

The blood vessels in your skin constrict, leaving you feeling cold and numb. The area affected depends on IE as follows: 1, digits (fingers and toes); 2, extremities (hands and feet); 3, limbs (arms and legs); 4, whole body. You take an additional (IE) × 10 percent cold damage. If the trait is degenerative, it will eventually lead to Thrombosis and amputation.

Real-world Examples

Raynaud’s Disease, Scleroderma, Lupus, Vasculitis, Ehlers Danlos Syndrome

Assistive Options

Wrapping the affected areas in heavy insulating clothing for warmth will reduce the IE by 1 while worn.

Magical Assistance

Spells and magic items that provide resistance to cold damage reduce the IE by 1 while in effect. If you have immunity to cold damage through magic protection, you will still take (IE) × 5 percent of the original cold damage.

You experience seizures. Choose or roll on the following table. If you remain aware and conscious during a seizure, you must succeed on a DC 8 + (IE) Constitution check to maintain concentration if needed.

function generateSeizure() { const rand = Math.floor(Math.random() * 100) + 1; let seizureType;

if (rand <= 40) { seizureType = "Focal Aware Seizures"; } else if (rand <= 60) { seizureType = "Focal Impaired Awareness Seizures"; } else if (rand <= 67) { seizureType = "Absence Seizures"; } else if (rand <= 77) { seizureType = "Myoclonic Seizures"; } else if (rand <= 82) { seizureType = "Clonic Seizures"; } else if (rand <= 88) { seizureType = "Tonic Seizures"; } else if (rand <= 93) { seizureType = "Atonic Seizures"; } else { seizureType = "Tonic Clonic Seizures"; } document.getElementById("seizureType").innerHTML = "Seizure Type: " + seizureType; }

• Focal Aware Seizures. You have a strange feeling for (IE)d20 seconds resulting in one of the following experiences.
  

  d8	Experience
  1	Nausea
  2	Unusual smell or taste: You smell or taste something with no known source. You have a −(IE) penalty on all Wisdom (Perception) checks related to smell and taste for the duration.
  3	Amplified Emotion (both kinds equally likely)
  4	Myoclonic Seizure in one random arm
  5	Numbness in one random limb
  6	Feeling like one random limb is larger or smaller than it actually is: you have a −(IE) penalty on all Dexterity attack rolls, ability checks, and saving throws with that limb for the duration.
  7	Perception of colored or flashing lights: You have a −(IE) penalty on all Wisdom (Perception) checks involving vision
  8	Hallucinations

• Focal Impaired Awareness Seizures. You become confused as if under the Confusion spell for (IE)d4 minutes.
• Absence Seizures. You become stunned and unaware of your surroundings for (IE)d4 seconds. You may carry on simple actions like walking, but you are unconscious as far as your mind and senses go.
• Myoclonic Seizures. Your muscles jerk (IE)d4 times, once every round. You have a −(IE) penalty on all Strength or Dexterity attack rolls, ability checks, and saving throws during a seizure and must succeed on a DC 5 + (IE) Dexterity saving throw or drop anything you’re holding in your hands. Any spell that you attempt to cast with a somatic component will fail but will not use your spell slot.
• Clonic Seizures. Your muscles have spasms that make your face, neck, and arm muscles jerk rhythmically. During this seizure, you have a −(IE × 2) penalty on all actions requiring the use of your arms and cannot cast spells requiring a somatic component. Casting a spell with a verbal component requires a successful DC 10 + (IE) Constitution check. Failure results in the spell failing, but it does not use a spell slot. Clonic Seizures last (IE)d6 rounds.
• Tonic Seizures. The muscles in your arms, legs, or trunk tense up. When this seizure begins, you must succeed on a DC 10 + (IE) Dexterity saving throw or become prone. On success, you must continue this check each round for the duration of the seizure. Your movement during the seizure is divided by the IE. Tonic Seizures last (IE)d4 rounds.
• Atonic Seizures. Your muscles suddenly become paralyzed, and you become prone. You must succeed on a DC 10 + (IE) Wisdom (Perception) saving throw to notice the onset of the seizure and to use an action to intentionally become prone. Failure results in falling and taking 2 (1d4) bludgeoning damage unless wearing a helmet. The seizure lasts (IE)d4 seconds, but you get (IE)d4 of them in a row with 1d4 rounds in between each of them.
• Tonic Clonic Seizures. Your body stiffens, jerks, and shakes, and you become unconscious. Sometimes you lose control of your bladder or bowels. This seizure lasts 1d(IE) × 2 minutes.

Real-world Examples

Epilepsy, Gray Matter Heterotopia, Traumatic Brain Injury, Lupus, Multiple Sclerosis

Assistive Options

Those with seizures benefit from someone watching them for the onset. A friend or ally nearby at the onset can use their action to help you, giving you advantage on checks against falling, bumping into something harmful, and other physical effects. You may also consult the section on Service Animals.

You are nearly always tired. After every long rest, you must succeed on a DC 8 + (IE) Constitution saving throw, or you do not benefit from the rest, regardless of the amount of rest you get. Spending an entire day resting will automatically give you advantage on the Constitution saving throw.

Real-world Examples

Chronic Fatigue Syndrome, Lyme Disease, Fibromyalgia, Lupus, Hypothyroidism, Multiple Sclerosis, Insomnia, Postural Orthostatic Tachycardia Syndrome

Assistive Options

Beginning a long rest three days in a row at roughly the same time grants a +1 bonus to the Constitution saving throws, keeping the pattern adding an additional +1 bonus cumulatively to a maximum of +5. Keeping a diet for at least seven days of fish, vegetables, and nuts gives a +1 bonus to the Constitution saving throw. Drinking more alcohol than (Constitution Bonus) drinks will negate this bonus. A weighted blanket during a short rest also gives a +1 bonus to the Constitution saving throw. Such a blanket can be made from two large animal pelts for a medium humanoid or two medium animal pelts for a small humanoid plus enough sand to make the total weight 10 percent of your body weight. The cost of fabrication is 20 gp.

Magical Assistance

If the fatigue is caused by Insomnia, a Sleep spell or other effect that mimics it will assist in getting to sleep during a long rest and will reduce the IE by 1 Extent until the next long rest.

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.

Your fingers, wrists, elbows, and/or shoulders (Roll 1d8 (IE) times, 1–4 = right side; 5–8 = left side) are difficult or impossible to move without extreme pain if at all. You have a −(IE) penalty on any action that would use that joint, including attack rolls. When you succeed on a melee attack, the vibrations from the impact are painful, and you need to succeed on a DC 8 + (IE) Constitution check to fight the pain and continue to hold your weapon.

Real-world Examples

Arthritis, Lupus, Bursitis, Gout

Assistive Options

A large quantity of fish or flaxseed can help joint stiffness. A diet of at least 1 fish or a serving of flaxseed once per day for seven days will reduce the IE by 1 as long as maintained. Missing a day will lose the benefit and require starting over. Spending one hour swimming or bathing in warm flowing water will reduce the IE by 1 for 2d6 hours.

Magical Assistance

The Telekinesis or Mage Hand spells and items that duplicate their effects can assist with this for minor tasks.

I look fine and healthy, but I’m not, and I can suddenly be in pain even if you can’t see it. I sometimes need to rest for my pain to subside even if I look alright.

– Diego Rodríguez

You experience chronic pain in your fingers, hands, and/or arms. Any action that requires concentration (e.g., maintaining a spell) requires a successful DC 10 + (IE) Constitution saving throw per round to maintain concentration. When you succeed on a melee attack, the vibrations from the impact are painful, and you need to succeed on a DC 8 + (IE) Constitution check to fight the pain and continue to hold your weapon. 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

Arthritis, Carpal Tunnel Syndrome, Tendinitis, Gout, Lupus, Neuropathy, Erythromelalgia

Assistive Options

Applying ice for 10 minutes or a compression bandage can reduce the pain by 1 IE for 10d6 minutes per day.

Magical Assistance

A healing spell can target the hands and arms and reduce the IE by 2 for 1 hour instead of regaining hp.

Your fingertips are more sensitive than most people’s, giving +(IE) on Wisdom (Perception) checks involving touch, but you are unable to wear gloves, gauntlets, or anything else on your hands without extreme discomfort. The GM may require Constitution checks for other hand sensitivity-related situations.

Real-world Examples

Finger Paresthesia, Arthritis, Lupus, Sjögren Syndrome, Gout, Scleroderma

Assistive Options

The best treatment is avoiding stimuli that cause discomfort.

Your eye sockets don’t produce enough moisture, so you need to use saline drops regularly, (IE) times every 12 minutes or have a −(IE) penalty on all sight-based rolls until applying saline drops or closing your eyes for at least 1 minute.

Real-world Examples

Posterior Blepharitis, Sjögren Syndrome, Rheumatoid Arthritis, Lupus, Sarcoidosis

Assistive Options

Characters must carry a skin of saline water to replenish the eyes’ moisture.