You feel the need to use repetitive physical stimulation (stimming) for (IE)d4 rounds to manage your emotions. Stimming can manifest as hand flapping or finger movements, rocking, unusual posture, watching a repetitive movement, making or listening to a song or noise repeatedly, manipulating a fidget device, or mouthing inedible objects or your own appendages. Aside from drawing negative attention from those who don’t understand this behavior, inability to stim can lead to emotional dysregulation. When needing to stim, if unable, you must succeed on a DC 3 + (IE) Wisdom check to fight the urge each round, the DC increasing cumulatively by (IE) each round until you meet your stimming needs. Failure to resist the urge causes a −(IE) penalty on all ability checks until you meet your stimming needs.

At IE 4, stimming may be self-injurious, such as hand-biting (succeed on a DC 5 Constitution saving throw or develop Infection), eye-poking (succeed on a DC 5 Constitution saving throw or develop Infection. On a critical failure, develop Refractive Difference), or head-banging (1 bludgeoning damage every 1d4 rounds).

Real-world Examples

Autism, Sensory Processing Disorder, Rett Syndrome, Fragile X Syndrome, Prader-Willi Syndrome, Attention Deficit Hyperactivity Disorder, Tourette Syndrome, Schizophrenia, Fronto-Temporal Dementia, Alzheimer’s Dementia

Assistive Options

While stimming is normally harmless and in fact helpful, if it gets in the way of achieving your goals or is self-injurious, some helpful options may include attempting to avoid the causal stimulus, which is not always possible. You may also attempt proactively stimming if expecting a triggering situation, which reduces the length needed later by 1d4 rounds and gives a +1 bonus to the Constitution saving throw to resist. Wearing a helmet or other protective gear that still allows you to get the needed stimulation but reduces or eliminates the resulting injury may also be possible for self-injurious stimming. Fidget items and chewelry sometimes provide a safe alternative to some injurious movements.

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.

Your eyelids move uncontrollably, making it difficult to focus. While this is occurring, you need to succeed on a DC 8 + (IE) Constitution check to maintain concentration on spells or to avoid a −(IE) penalty on all ranged attack rolls for the round. Occasionally (Roll (IE) or under on 1d20 each time it happens or every hour if Acute), the spasm causes your eye to close completely for 3d20 minutes, giving disadvantage to Wisdom (Perception) checks on that side for the duration.

Real-world Examples

Blepharospasm, Hemifacial Spasm, Parkinson’s Disease, Tourette Syndrome

Assistive Options

This trait has no mundane treatments.

Magical Assistance

The Suggestion spell can stop this trait for the duration.

You have a facial tic that causes the muscles in your face to move involuntarily. Tics may include blinking eyes, flaring nostrils, raising eyebrows, grimacing, clicking the tongue, clearing the throat, grunting, and other involuntary verbalizations. This Tremor lasts (Frequency × 1d20 turns) when activated and activates (Frequency × 1d100) times per day. You have −(IE) on Charisma (Persuasion) checks while the Tremor occurs.

Real-world Examples

Tourette Syndrome, Transient Tic Disorder, Chronic Motor Tic Disorder, Hemifacial Spasms, Blepharospasms, Facial Dystonia

Assistive Options

If you spend a short rest meditating and using relaxation techniques, you can succeed on a DC (IE × 5) Wisdom saving throw to stave off Tremor for 1d4 hours. Taking damage, Barbarian Rage, and other intense situations will negate these benefits.

A DC 15 Intelligence (Nature) check followed by a DC 10 Wisdom (Medicine) check will enable you to locate and blend soothing herbs that can be ingested to reduce the Tremor by 1 IE for 1d4 hours.