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 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.

Real-world Examples

Depression, Schizophrenia, Parkinson’s Disease, Chronic Pain

Assistive Options

Assistance involves compassionate patience by trustworthy allies who acknowledge your experience.

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.

You have trouble with larger body movements, such as jumping, throwing, walking, running, and maintaining balance. You have a −(IE) penalty on all melee attack rolls to hit and Strength (Athletics) and Dexterity (Acrobatics) checks and Dexterity saving throws. Spells with somatic components usually need to be modified to work within your physical range, requiring (IE) days for every hour normally needed to inscribe into your spellbook and double the cost due to experimentation materials. You may replace one of your other traits with Muscle Control & Gait Difference.

Real-world Examples

Dyspraxia, Friedreich’s Ataxia, Wilson’s Disease, Parkinson’s Disease, Multiple Sclerosis, Cerebral Palsy, Paraneoplastic Syndromes, Neuropathy, Spinal Injuries

Assistive Options

Leg braces, crutches, walkers, rollators, and canes can reduce the IE penalty by 1 for Dexterity checks and saving throws. Braces take one minute to put on and cannot be worn while sleeping, and the others, unless designed for use as weapons, require one hand to be used for balance.

You have trouble making precise movements, especially with your hands and arms. You have a −(IE) penalty on all Dexterity (Sleight of Hand) checks, Dexterity checks to write, or other attempts to use precision with your hands such as playing a musical instrument. Spells with somatic components usually need to be modified to work within your physical range, requiring (IE) days for every hour normally needed to inscribe into your spellbook and double the cost due to experimentation materials. Transcribing spells with only verbal components into your spellbook takes (IE) × 4 times as long as usual.

Real-world Examples

Dyspraxia, Friedreich’s Ataxia, Wilson’s Disease, Parkinson’s Disease, Multiple Sclerosis, Cerebral Palsy, Paraneoplastic Syndromes, Neuropathy, Spinal Injuries

Assistive Options

Assistance for fine motor control loss takes the form of adapting the space around you to your needs and allowing extra time for anything requiring fine motor movements.

You experience sudden painful tightening of muscles in your body with little or no warning. This tightness makes the cramped part of your body completely unusable and distracting. This cramp may always be in the same body part or travel around the body, typically in the same region. The cramp lasts (IE)d4 minutes. At the end of the duration, you must succeed on a DC 8 + (IE) Strength saving throw or the cramp moves to a different part of the same region of the body, such as lower abdomen to upper abdomen or from calf to shin or from left leg to right leg for another (IE)d4 minutes, after which you must succeed on a DC 8 + (IE) Strength saving throw or continue the process, the DC decreasing by 1 each time. Any action that requires concentration (e.g., maintaining a spell) requires a successful DC 10 + (IE) Constitution saving throw per round to maintain concentration.

Real-world Examples

Restless Leg Syndrome, Diabetes, Addison’s Disease, Kidney Failure, Parkinson’s Disease, Cirrhosis, Sarcoidosis

Assistive Options

When a cramp starts, if you can continuously stretch the affected muscle, which gives disadvantage on all other physical actions except saving throws, you get a +1 bonus to the next Strength saving throw.

Most or all movements that you make are reduced by (IE) × 15 percent. You have a −(IE × 2) penalty on all Strength (Athletics) and Dexterity checks, saving throws, and your Armor Class. 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.

Real-world Examples

Parkinson’s Disease

Assistive Options

You need people to remember that your mind is still as quick as ever, but your body won’t cooperate with your desired speed, and they need to be patient.

Magical Assistance

A Haste spell or something that duplicates its effects can reduce the IE by 2 but also has the accompanying side effects.

You have trouble sleeping, or your sleep is disrupted in some way. Note the rules on p. 87 of the Basic Rules regarding rest and other fifth edition sources regarding exhaustion. As elves and other creatures of fey ancestry don’t sleep, the GM can determine whether they should reroll or whether this affects their meditative condition. If you have multiple traits, you may choose one or more Baseless Emotions as one or more of them.

• Confusional Arousals. You wake from sleep and act as if under a Confusion spell for (IE)d10 minutes and then return to sleep. You retain no memory of waking up.
• Exploding Head. As you awaken from sleep, you hear loud explosions. They startle you, and you must succeed on a DC 5 + (IE) Wisdom saving throw or have disadvantage on all Intelligence and Charisma checks for (IE) rounds but have +1 to initiative rolls due to hyperawareness.
• Hypersomnolence. While you might seem to sleep fine at night, you still feel Fatigue during the day. You have a −(IE) penalty on saving throws against magic effects that induce sleep, and (IE)d4 times per day, you must succeed on a DC 8 + (IE) Constitution saving throw or become unconscious as if affected by the Sleep spell. (This condition could be ruled to cause characters of fey ancestry to need to sleep when they normally don’t.)
• Insomnia. You have trouble falling or staying asleep or both (equal chances of each). When beginning a long rest, you must succeed on a DC 8 + (IE) Constitution saving throw to fall asleep quickly. On failure, you lose the difference between your result and the number needed in hours of sleep and lose benefits of rest accordingly unless you sleep longer at the end of the long rest to compensate. If your form of insomnia wakes you while sleeping, determine the time you wake randomly by subtracting the loss from the total hours attempted, and roll 1d(difference) to determine how many hours you sleep before waking. If your insomnia is mixed, follow the above, but then roll to determine how many of the lost hours are at the beginning and how many happen after waking.
• Night Terrors. When you’re sleeping, you awaken at a random time during the rest and scream for (IE)d12 minutes. Each time this happens, you must succeed on a DC 5 + (IE) Constitution saving throw or have another screaming episode in 1d20 minutes, repeating until success. This will awaken anyone else sleeping near you who can hear and draw the attention of any nearby creatures. If awakened, you will be disoriented for (IE) rounds and have disadvantage on all Intelligence and Charisma checks.
• Nightmares. You experience frequent, vivid nightmares. Every time you sleep, you must succeed on a DC 15 + (IE) Constitution saving throw or have a nightmare 1d4 hours after falling asleep. The dream lasts 1d10 + 10 minutes. After the dream, you must succeed on another DC 15 + (IE) Constitution saving throw or have a nightmare 1d4 hours later, repeating the process until the end of the rest. Because of the trauma of these dreams, you experience (IE) Baseless Emotions for (IE)d6 × 10 minutes before a long rest and must succeed on a DC 10 + (IE) Wisdom saving throw to go back to sleep after the dream, repeating the saving throw every ten minutes on failure until successful.
• Sleep Aggression. You act violently while sleeping. Every time you sleep, you must succeed on a DC 15 + (IE) Constitution saving throw or begin attacking the closest creature with unarmed attacks 1d4 hours after falling asleep. The episode lasts until you take damage or succeed on a DC 10 + (IE) saving throw, which you can attempt each round. After the attack, you must succeed on another DC 15 + (IE) Constitution saving throw or attack again 1d4 hours later, repeating the process until the end of the rest. If your companions restrain you before sleeping, you must succeed on a DC 8 Constitution saving throw or experience Insomnia due to the discomfort of the restraint unless the method allows freedom of movement, such as a cage, and when the episode begins, you attempt to escape the restraint until the episode ends. With IE 1 Sleep Aggression, you remain prone and only attack anyone in bed with you or within your reach if you’re sleeping on the floor or a mat, but at a higher IE, you will get out of bed to attack.
• Sleep Behaviors. Every time you sleep, you must succeed on a DC 15 + (IE) Constitution saving throw or have a nightmare 1d4 hours after falling asleep. The dream lasts 1d10 + 10 minutes. During the nightmare, you act out the dream and perceive the creatures around you as the villains or monsters in your dream. You begin to twitch and moan, which escalates in 1d20 rounds to attacking if not awakened. On a successful DC 8 + (IE) Wisdom saving throw, you attack the nearest creature. On a failed saving throw, you are frightened and flee. You can be easily awakened by normal means or when you take damage. After the dream, you must succeed on another DC 15 + (IE) Constitution saving throw or have a nightmare 1d4 hours later, repeating the process until the end of the rest.
• Sleep Enuresis. You urinate while sleeping (IE)d4 times per week. Without support and understanding from allies, you must succeed on a DC 10 + (IE) Wisdom saving throw once per week or experience 1d4 Baseless Emotions until succeeding, making the saving throw once per day.
• Sleep Paralysis. When you awaken from sleep, you are paralyzed for (IE)d4 minutes. Because of the trauma of this experience, you must succeed on a DC 10 + (IE) Wisdom saving throw or experience (IE) Baseless Emotions for (IE)d6 × 10 minutes before a long rest.
• Sleep Sorcery. Every time you sleep, you must succeed on a DC 8 + (IE) Constitution saving throw or cast a random prepared spell at the lowest available spell slot 1d4 hours after falling asleep. After the casting, you must succeed on another DC 8 + (IE) Constitution saving throw or cast another spell 1d4 hours later, repeating the process until the end of the rest. If you do not have the necessary spell slot available or if you do not have the necessary focus or components within reach, the spell fails, and nothing happens. When the rest finishes, you will have used up spell slots for all spells successfully cast within four hours of the end of the rest.
• Sleep-Related Breathing Disruptions. You don’t get enough oxygen while sleeping, either due to apnea, chronic snoring, discharge, or failure to absorb enough. You experience IE 1 Fatigue, and every twenty-eight days, you must succeed on a DC 5 + (IE) Constitution saving throw or develop IE 1 Hypertension, the IE increasing on each failed periodic saving throw.
• Sleep-Related Hallucinations. When falling asleep or waking up (both equally likely), you experience Hallucinations.
• Sleep-Related Movements. You move excessively in your sleep, either random movements, leg Cramps, or teeth grinding, which keeps you from getting sufficient rest. At the end of every long rest, you must succeed on a DC 8 + (IE) Constitution saving throw or incur IE 1 Fatigue for the rest of the day.
• Sleep-Wake Disruption. Your internal sleep clock does not correspond to your intended pattern. If you cannot follow your internal pattern, follow the rules for Insomnia accordingly.
  

  d10	1d10 if you have IE 4 Blindness	Sleep-Wake Disruption
  1–4	1–3	Irregular Rhythm
  5–9	4–7	Delayed Phase
  10	8–10	Non-synchronized Circadian Rhythm

  • Irregular Rhythm. In order to achieve the benefits of a long rest, you must instead take (IE) short rests.
  • Delayed Phase. Your pattern of sleep begins (IE) × 3 hours before or after the time typical for your culture, and in order to gain the benefits of a long rest, you must begin your long rest within one hour of that time.
  • Non-synchronized Circadian Rhythm. Your internal sleep clock functions as if the day is (IE) hours longer or shorter (equal chances) than it actually is, which adjusts the time your body expects to take a long rest to a new time every day.
• Sleepwalking. Every time you sleep, you must succeed on a DC 15 + (IE) Constitution saving throw or have a dream 1d4 hours after falling asleep. The dream lasts 1d10 + 10 minutes. You act out your dream, walking, interacting with your environment, but with disadvantage on all Wisdom (Perception) checks. The GM should determine the nature of the nonviolent dream. If awoken while sleepwalking, you will be disoriented and have disadvantage on all Intelligence and Charisma checks for 1d10 rounds. An ally can make a DC 8 + (IE) Charisma (Persuasion) check to gently guide you back to bed on success.

Real-world Examples

Sleep Apnea, Sleep-related Hypoventilation Disorders, Sleep-related Hypoxemia Disorder, Kleine-Levin Syndrome, Delayed Sleep Phase Disorder, Sleep-wake Phase Disorder, Irregular Rhythm Sleep-wake Disorder, Non-24 Sleep-wake Disorder, Narcolepsy, Parkinson’s Disease, Lewy Body Dementia, Down Syndrome

Assistive Options

Most of these require patience and understanding by your allies most of all. If a party sets up a night watch, the person watching can also monitor you while you sleep and wake you if necessary when noticing behavior relating to disrupted sleep. Earplugs and a sleep mask or an otherwise dark and quiet environment can assist with sleep phase disruptions to allow for sleeping in sunlight and daytime activity.

Magical Assistance

A Sleep spell can help you get back to sleep when you can’t sleep, but it has no duration, so it won’t prevent waking or other traits that occur during sleep.

You have trouble communicating using language, including speaking, understanding, and writing. Choose or roll on the following table. You have 1d6 of the following patterns.

• Dysgraphia. Your writing appears haphazard, with irregular spelling and spacing, such as missing spaces between words and spaces in the middle of words. Anyone attempting to read your writing must succeed on a DC 8 + (IE) Wisdom (Perception) check. You can write conventionally with extreme effort, requiring you to concentrate by making a DC 10 + (IE) Constitution check per sentence, adding (IE) cumulatively per sentence but also adding (IE) to any quality-related checks due to the additional scrutiny. Any conventional writing after that requires a short rest. Transcribing spells into your spellbook takes (IE) × 10 times as long as usual.
• Reiterative Agraphia. When you write, you tend to repeat words and letters, making your writing difficult to read. Anyone attempting to read your writing must succeed on a DC 8 + (IE) Wisdom (Perception) check. You can write conventionally with extreme effort, requiring you to concentrate by making a DC 10 + (IE) Constitution check per sentence, adding (IE) cumulatively per sentence but also adding (IE) to any quality-related checks due to the additional scrutiny. Any conventional writing after that requires a short rest. Transcribing spells into your spellbook takes (IE) × 10 times as long as usual.
• Specialist Agraphia. You are unable to write in a specific format tied to your class/profession, such as writing spells, musical notation, alchemical formulae, written Thieves’ Cant, etc. You can write conventionally with extreme effort, requiring you to concentrate by making a DC 10 + (IE) Constitution check per sentence, adding (IE) cumulatively per sentence but also adding (IE) to any quality-related checks due to the additional scrutiny. You cannot inscribe spells into your spellbook and must find or hire someone of your level or higher to assist you in doing so. The typical fee of this task is 25 gp × (spell level), but the scribe will often do so in exchange for the option to make a copy of the spell for themselves if they don’t already have it.
• Dysexecutive Agraphia. You have trouble organizing your thoughts, so your writing includes sentences out of order or words out of order in sentences, like a verbal jigsaw puzzle. You cannot write any kind of ordered directions unless taking dictation. You can write conventionally with extreme effort, requiring you to concentrate by making a DC 10 + (IE) Constitution check per sentence, adding (IE) cumulatively per sentence but also adding (IE) to any quality-related checks due to the additional scrutiny. Anyone attempting to read your writing must succeed on a DC 8 + (IE) Wisdom (Perception) check. Transcribing spells into your spellbook takes (IE) × 5 times as long as usual.
• Apraxic Agraphia. You can read and speak, but you can’t write in any meaningful form. You cannot inscribe spells into your spellbook and must find or hire someone of your level or higher to assist you in doing so. The typical fee of this task is 25 gp × (spell level), but the scribe will often do so in exchange for the option to make a copy of the spell for themselves if they don’t already have it.
• Lexical Agraphia. You can only spell & read phonetically. Irregularly spelled words are like an unknown language to you. Anyone attempting to read your writing must succeed on a DC 5 + (IE) Wisdom (Perception) check. When you try to read something, you must succeed on a DC 8 + (IE) Wisdom (Perception) check to get the gist of the writing, and you cannot use spell scrolls. Transcribing spells into your spellbook takes (IE) × 5 times as long as usual and the assistance of a caster able to cast that spell. The typical fee of this task is 25 gp × (spell level), but the scribe will often do so in exchange for the option to make a copy of the spell for themselves if they don’t already have it.
• Semantic Agraphia. When you write, you tend to substitute related (but not synonymous) words, so when you want to write, “pirate,” you instead write, “ship” or “sea.” You can write conventionally with extreme effort, requiring you to concentrate by making a DC 10 + (IE) Constitution check per sentence, adding (IE) cumulatively per sentence but also adding (IE) to any quality-related checks due to the additional scrutiny. Any conventional writing after that requires a short rest. Transcribing spells into your spellbook takes (IE) × 10 times as long as usual.
• Phonological Agraphia. You cannot sound out words to read them, relying only on recognition of words whose spellings you’ve memorized. This memorization is closely tied to your senses, so you especially have trouble reading abstract words. Reading requires a successful DC 8 + (IE) Wisdom (Perception) check to read about a concrete object with a higher DC, or depending how abstract the content is, a spell scroll having a DC 15 + (IE) + (spell level). It takes you (IE) + 1 times as long to prepare a spell. Transcribing spells into your spellbook takes (IE) × 5 times as long as usual and the assistance of a caster able to cast that spell. The typical fee of this task is 25 gp × (spell level), but the scribe will often do so in exchange for the option to make a copy of the spell for themselves if they don’t already have it.
• Visuospatial Agraphia. Your writing takes irregular spacing and forms. It may not be in a straight line, or it may only be in a corner of the page, words and letters overlapping, duplicate lines when writing letters, etc. Anyone attempting to read your writing must succeed on a DC 8 + (IE) Wisdom (Perception) check. Transcribing spells into your spellbook takes (IE) × 5 times as long as usual and the assistance of a caster able to cast that spell. The typical fee of this task is 25 gp × (spell level), but the scribe will often do so in exchange for the option to make a copy of the spell for themselves if they don’t already have it.
• Alexia. You can spell and write, but you can’t read, even something you just wrote, unless you succeed on a DC 15 + (IE) Wisdom check per sentence. You cannot use spell scrolls, and to prepare a spell, you need someone of your class who is high enough level to cast the spell who must read the spell to you from your spellbook and help you prepare it. The reader may prepare the spell for themselves at the same time. Because you’ve learned to write without reading or editing what you write, you can transcribe spells into your spellbook in half the usual time, but you must succeed on a DC 8 + (IE) check of your casting stat to accurately transcribe the spell unless you have help.
• Expressive Aphasia. You can understand language but have trouble speaking, uttering short phrases at best. To speak, you must succeed on a successful DC 8 + (IE) Constitution check for each phrase. You cannot use spell scrolls, and spells with a verbal component require you to modify them to 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. Communication via writing can be done without penalties.
• Receptive You can speak, but your sentences are incoherent and contain unnecessary words. However, you don’t realize others have trouble understanding you, and you have trouble understanding spoken language. For your speaking to be understood, the listener must succeed on a DC 8 + (IE) Wisdom (Perception) check, and you must do the same to understand the gist of anything said to you. You cannot use spell scrolls, and spells with a verbal component require you to modify them to add additional somatic components if possible to avoid needing verbal components. 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. Communication via writing can be done without such penalties.
• Anomic Aphasia. You have trouble finding the right words for what you want to talk about, both in speech and writing, so you have to use other words instead, which may seem vague. You have a −(IE) penalty on Charisma (Persuasion) checks, but because you’re used to manipulating language to express yourself, you have a +(IE) bonus to verbal and written Charisma (Deception) checks.
• Global Aphasia. You can speak and understand very little spoken language. To understand or communicate information in a verbal conversation, you must succeed on a DC 12 + (IE) Intelligence saving throw to determine whether your brain allows you to form and process enough applicable words.

Real-world Examples

Aphasia, Agraphia, Dysgraphia, Alexia, Gerstmann Syndrome, Parkinson’s Disease, Tourette Syndrome

Assistive Options

Spending a short rest preparing for a known upcoming situation or other language need will reduce the IE by 1 (to a minimum of 1) for 1d4 hours. Aphasia does not affect sign language, so you can use signs or written language as alternatives.