Mental Disorders

Anxiety Disorders

Anxiety disorders generally develop from a variety of risk factors including personality, genetics, and life events that burden the character. When this anxiety builds over a prolonged period of time (especially when combating frightful creatures), the character may begin to develop an anxiety disorder.

Generalized Anxiety Disorders

The character suffers from a variety of physical and emotional symptoms that can be grouped into certain categories.

Motor Tension

The character suffers from jitteriness, aches, twitches, and so on. All attack rolls, saving throws, and ability checks involving Strength, Dexterity, or Constitution have disadvantage.

Automatic Hyperactivity

The character suffers from immense sweating, a racing heart, dizziness, clammy hands, and so on. All saving throws and ability checks have disadvantage.

Expectations of Doom

Anxieties culminate into a fear and an anticipation of misfortune. All attack rolls and ability checks have disadvantage.

Vigilance

The character suffers from distractions, inability to focus, insomnia, and so on. All saving throws and checks involving Intelligence, Wisdom or Charisma have disadvantage.

Agoraphobia

The character has a fear of open places. The character becomes very nervous outside familiar surroundings and must make a DC 15 Wisdom save in order to leave home or engage socially. The character may also develop a related phobia, such as uranophobia (fear of the sky), baraphobia (fear of the loss of gravity), or xenophobia (fear of strangers).

Obsessive-Compulsive Disorder

This malady develops into two forms obsessive thoughts or compulsive actions. Some characters may exhibit both.

Obsessions

The character cannot help thinking about an idea, image, or impulse incessantly, often involving violence and self-doubt. Obsessive impulses pose dangerous situations when coupled with auditory hallucinations. There might be “voices” urging the character to take a dangerous or aggressive course of action.

Compulsions

The character insists on performing ritual actions, such as locking and unlocking doors, before entering or leaving their apartment. The need to perform these actions are so great, a character may ignore their survival in order to perform these actions. Performing a ritualistic compulsion lasts 1d10 rounds.

Phobia or Mania

A character afflicted by a phobia or a mania persistently fears a particular object or situation.

Phobia

A DC 15 Wisdom saving throw is required for a character to be able to force themselves into (or remain within) the presence of the object of their phobia. On a success, the character has disadvantage on attack rolls and ability checks relating to the object. On a failure, the character is frightened and must flee from the object of the phobia.

Philia

Philias are rarer than phobias. A character affected by a philia is inordinately fond of a particular stimulus and takes great pains to be with or near it. For example, a character with Hematophobia has a fear of blood while a character with Hematophilia has an unhealthy attraction to the act of bleeding. Resisting the impulse to indulge their mania or philia is a DC 15 Wisdom saving throw.

Dissociative Disorders

A character who becomes dissociative suffers from a lack of connection to thoughts, memories, feelings, actions, or sense of identity. Certain ordeals are so horrifying for the character that it becomes too terrible to remember.

Dissociative Amnesia

This is the inability to recall important personal information by trying to avoid unpleasant memories or events. The character must make a DC 20 Intelligence check to recall such details or the cause of amnesia. This check can be tried once per day after benefiting from a long rest. At the GM’s discretion, this may or may not affect a Wizard’s ability to memorize and prepare spells, but it is more likely than not that a wizard is not denied their spellcasting just as they retain their ability to perform other skills or tasks with no problem.

Dissociative Fugue

The character flees from home or work and cannot recall their past. Characters may assume a new identity.

Dissociative Identity Disorder

This is the infamous multiple personality disorder that has provoked the production of many films and books. Each personality a character harbors has a distinct name, behavior, and possibly, even gender. The player needs to keep track of each of the character’s different personalities (each character has the same ability scores and games statistics, but different goals, outlooks, attitudes and so on).

Impulse Control Disorders

These disorders include compulsive gambling, pathological lying, kleptomania, and pyromania.

Mood Disorders

These affect the character’s outlook and attitude to the point where it impinges on their abilities.

Depression

This disorder may include symptoms of weight gain or loss, too much or too little sleep, persistent feelings of guilt or worthlessness and can lead to hallucinations, delusions, stupor, or thought of suicide. The character will continue to accrue levels of exhaustion while suffering from depression until they reach 5 levels. These levels cannot be removed by normal or magical means until the underlying issues have been addressed. The character only dies from exhaustion if they have received 6 levels of exhaustion that are from a source outside of this mental illness.

Mania

The character possesses a constant euphoric or irritable mood. This includes talkativeness, great delusional self-esteem, no need for sleep, easily distracted, and so on. A character rolls a d20 at the start of their turn. On a natural 1, they lose focus and take a random action that does not involve attacking or helping allies, such as picking flowers or dancing a jig.

Bipolar Mood Disorder

The character changes between the two mood states staying in one mood for weeks at a time or rapidly switching from one to another without notice.

Personality Disorders

These disorders cause an unpleasant behavior, making it difficult for characters to interact with others. The character has disadvantage all Charisma-based checks. Especially bad checks can sometimes lead to creating hostile relationships with NPCs.

Psychospecies Disorders

Characters with this disorder might believe they are a different type of creature, animal, undead, aquatic, and so on.

Schizophrenia Disorders

Characters suffering from this disorder suffer a break from reality. Symptoms include hallucinations, delusions, and cognitive impairment. Characters with this impairment have disadvantage to pierce illusions or avoid the effects of illusion school spells.

Sleep Disorders

Insomnia and narcolepsy are two of many types of sleeping disorders. These disorders cause a disturbance in the character’s daily activities. Characters performing demanding tasks such as engaging in combat or casting a spell may, when stressed, need to make a DC 15 Constitution saving throw to stay awake and not put themselves in a dangerous situation.

Somatoform Disorders

These disorders are diagnosed when a character suffers from physical symptoms without actual physical injury or disease.

Somatization Disorder

The character suffers from a physical ailment or disease-like effect. Symptoms can include dizziness or impotence to blindness and intense pain. The character does not believe that their symptoms represent a specific disease. Treat as poisoned.

Conversion Disorder

The character has dysfunctions that suggest a physical disorder, though involuntary, the symptoms actually provide a way for the character to avoid some undesirable experience. Treat as poisoned.

Substance Abuse Disorders

Characters with a substance abuse disorder find comfort in using a particular drug. This includes alcohol, amphetamines, cocaine, hallucinogens, marijuana, and so on. Characters should feel a daily personal struggle and Wisdom saving throws might be used to resist or succumb to such cravings.
When sober, the character must make a Constitution saving throw after benefiting from a long rest. On a failure, the character is poisoned. If the character fails by 5 or more, they are intensely physically ill and do not gain the benefits of the long rest. This saving throw must be made until the character is free from the disorder or they indulge in the substance.

Personality Disorders

Here is a list of potential personality disorders that might otherwise not seem like insanities, but could be spun that way, especially if they become severe or overriding personality traits.
Antisocial Reckless behavior, habitual liar, and so on.
Avoidant Low self-esteem or socially withdrawn.
Borderline Impulsive or unable to control.
Compulsive Perfectionist, authoritarian, or indecisive.
Dependent Lacks self-confidence or subordinate.
Histrionic Craves attention and excitement.
Narcissistic Craves attention and admiration.
Passive-Aggressive Stubborn and deliberately inefficient.
Paranoid Jealous, humorless, or secretive.