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Recovering from a madness without magical aid is a lengthy process requiring significant rest.

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Instead of relying on her own strength of personality to reduce the effects of madness, a character can also seek out a single confidante, priest, or other advisor. The recovering character must meet with that person regularly at least 8 hours each day and gain guidance during the 7 days of rest. At the end of the rest period, the ally can attempt a Wisdom or Intelligence check whichever is higher with a DC of 15 for a lesser madness or a DC of 20 for a greater madness.

Certain spells can also aid in recovery from madnesses or cure them outright. Lesser restoration has no effect on greater madnesses, but reduces the current DC of one lesser madness afflicting the target by 2, up to once per day. Restoration and heal reduce the current DC of one lesser madness afflicting the target by 5 or of one greater madness afflicting the target by 2, up to once per day each. A character suffering from delirium experiences decreased cognition and attention.

Often she has no real sense of this decline, or feels extremely frustrated when she does realize her concentration is impaired. Physical diseases, poisons, and ailments can also cause delirium. The afflicted character believes something that is not true, and no amount of evidence can dissuade him of the belief. A delusion is the persistence of a belief that no amount of evidence to the contrary can dissuade the afflicted character from having. The belief is often that another specific person either loves or wants to harm the afflicted character, or the afflicted character may have an inflated view of his own abilities or importance.

Sometimes the deluded character believes he suffers from an affliction or persecution that does not exist. The exact nature of the delusion is decided by the GM. In some circumstances, delusions can be debilitating, while in others they are merely quirky or annoying to those around the character.

Dormancy Effect —2 penalty on Will saving throws. A character suffering from a fugue cannot remember things; her name and her past are all equal mysteries. While the character can build new memories, she has trouble accessing those gained before she was inflicted with this madness.


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While a character in a fugue state can still speak and read any languages she knows and does not lose any of her skills, feats, or skill ranks, she does not remember how she learned such things, and is often surprised when using complex abilities. Dormancy Effect The afflicted character takes a —2 penalty on Will saving throws against or to disbelieve illusions. Most hallucinations are intermittent and produce a muddling of reality. Each round when an afflicted character is within 30 feet and can see the object of her mania, she must succeed at a Will saving throw or rush to interact with that object.

If the afflicted character succeeds at the saving throw by 5 or more, she can keep away from the object of the mania or resist the manic activity for 1 minute before having to attempt the saving throw again. Dormancy Effect Each round when an afflicted character is within 30 feet and can see the object of her mania, she must attempt a Will saving throw. If she fails, she can choose to either interact with the object of her mania as above or become fascinated by the object while abstaining from the activity for 1 round. A mania is an irrational and unhealthy obsession with an object or activity.

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Nearly any object or activity can become the object of a mania, but often the object is either dangerous like fire or deadly magic or somewhat taboo like the need to commit small thefts or engage in risky sexual behavior. A character suffering from melancholia struggles with severe pessimism and can often be slow to respond to threats and events going on around him. He can seem quiet and withdrawn, and his sense of enthusiasm is dulled.

In extreme cases, a character suffering from melancholia becomes entirely introverted and utterly withdrawn, even to the point of near catatonia. Each night when the afflicted character sleeps, she must succeed at a saving throw or wake up fatigued see below. A character suffering from night terrors is plagued by persistent terrifying dreams, worry, or terror that impedes her from getting restful sleep.

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Each night the afflicted character must succeed at a saving throw or wake up fatigued , though multiple nights of night terrors do not increase the condition to exhausted , and an exhausted character with night terrors wakes up after 8 hours of sleep either rested or fatigued based on the success or failure of the saving throw for this affliction.

Often a character suffering from night terrors will bolt upright during sleep, eyes open, and scream, though less-dramatic symptoms are also possible. When the afflicted character attempts a Sense Motive check, the GM rolls the check in secret, and failure gives the afflicted character the impression that those whose motives he is trying to sense are plotting against him in some way. Lastly, any time the afflicted character tries to use or gain a benefit from the aid another action, or is the target of a beneficial spell or effect from an ally, he must succeed at a Will saving throw in order to take the aid another action or gain the benefit from the action, spell, or effect.

A paranoid character is convinced that the world and society are conspiring toward his ruin. Typically those afflicted with paranoia are fidgety, argumentative, sullen, or extremely introverted. Each round an afflicted character is within 30 feet and can see the object of her phobia , she must succeed at a Will saving throw or become shaken.

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The next round, the afflicted character can choose to attempt another saving throw to end the effect, but if she fails, she becomes scared instead. A scared character can choose to attempt another saving throw to become shaken again, but if she fails, she becomes frightened for 1d6 rounds instead. Dormancy Effect Each round an afflicted character is within 30 feet and can see the object of her phobia , she must succeed at a Will saving throw or become shaken for 1 round.

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A phobia is an irrational fear of an object or activity. Nearly any object or activity can become the focus of a phobia, but often the object is either very specific like all spiders, no matter how big or small, or clowns or something that could be hazardous in some situations like heights or water but could be made relativity safe with magical or mundane precautions.

In existing rules, lesser restoration has no effect on insanity, but under these rules it can be used to treat lesser madnesses. Conversely, greater restoration , heal , and psychic surgery have reduced effects against greater madnesses in this system compared to in the previous books.

This allows madnesses to play a larger part at both higher and lower levels in horror games, or any other game featuring psychological threats. If you want to feature the madnesses as afflictions that are simple to remove for high-level spellcasters while outside the reach of anyone else—as per the more baseline experience—assume lesser madnesses are not affected by lesser restoration , and greater restoration , heal , and psychic surgery remove all madnesses, whether lesser or greater.

Dormancy Effect Unlike other madnesses, the normal effect and the dormancy effect of amnesia are the same. A character suffering from amnesia cannot remember things; his name, skills, and past are all equal mysteries. While the character can build new memories, he has trouble accessing those gained before he contracted amnesia. A character with this affliction loses all class abilities, feats, and skill ranks gained before contracting amnesia.

If a character gains a character level while suffering from amnesia, he can use any abilities gained via that class level normally. If the class level he gained was of a class in which he already had levels, he initially gains the abilities of a 1st-level character of that class, even though he is technically of a higher level in that class, and then progresses from there. When the amnesia is cured, the character regains the full abilities of the class; recalculate his level based on his total XP.


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The afflicted character acts as if she were cowering , but this is not a fear effect, unlike other forms of cowering. Dormancy Effect The afflicted character is staggered. A character suffering from catatonia mentally shuts down completely, or nearly so, greatly limiting her physical capabilities as well. While a catatonic character still breathes, she can eat or drink without assistance only if the catatonia is dormant.

If a catatonic character is faced with a dangerous situation, she must attempt a saving throw. If she succeeds, she acts as if panicked though this is not a fear effect until she is out of line of sight of the danger or is cornered. If she is cornered, she cowers again. The afflicted character can no longer speak or write and has difficulty concentrating.

He can no longer use command word items, spell-trigger items, or spell-completion items. He takes a —10 penalty on concentration checks. He cannot cast spells with a verbal or thought component, and cannot prepare spells from a spellbook. Dormancy Effect The afflicted character takes a —4 penalty on concentration checks.

This affliction deprives a character of his concentration and his ability to speak, read, and write, though he can understand words he hears and can react to requests and commands as normal. Dormancy Effect —2 penalty on Will saving throws and Wisdom-based checks.

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This is a complicated affliction that manifests as two or more distinct and different personalities in the same mind. The number of personalities is up to the GM, as is the nature of the personalities. Should the affliction worsen in some way such as by gaining dissociated identity again , the number of additional personalities might increase as well. If the afflicted character has more than one personality because of this madness, the manifested personality is either randomly chosen or chosen by the GM.

Once per day, the afflicted character can attempt a Will saving throw to suppress this effect for 24 hours. A character afflicted by moral insanity might plot the demise of friends and enemies alike, but always with the goal of avoiding blame or consequences and enabling him to continue to feed his dark desires. The impact of moral insanity must be roleplayed, although not all players may find it fun or interesting to play such a character. In such cases, the GM should assume control of the character whenever the madness is dominant. The afflicted character becomes blinded or deafened , loses another special sense like scent or blindsense , loses the use of limbs, or loses a special movement speed like a fly or swim speed.

The GM chooses how the psychosomatic loss manifests. While there is nothing physically wrong with the afflicted character, some kind of mental trauma has forced her brain to shut down sensory or motor systems. Dormancy Effect cannot take 10 or take 20 on any check. A character afflicted with schizophrenia can no longer function as he once did, dealing with sudden deficits in social skills and cognition, and an influx of new, strange behaviors.