5e SRD >Gamemastering >



    A plague ravages the kingdom, setting the adventurers on a quest to find a cure. An adventurer emerges from an ancient tomb, unopened for centuries, and soon finds herself suffering from a wasting illness. A warlock offends some dark power and contracts a strange affliction that spreads whenever he casts spells.

    A simple outbreak might amount to little more than a small drain on party resources, curable by a casting of lesser restoration. A more complicated outbreak can form the basis of one or more adventures as characters search for a cure, stop the spread of the disease, and deal with the consequences.

    A disease that does more than infect a few party members is primarily a plot device. The rules help describe the effects of the disease and how it can be cured, but the specifics of how a disease works aren’t bound by a common set of rules. Diseases can affect any creature, and a given illness might or might not pass from one race or kind of creature to another. A plague might affect only constructs or undead, or sweep through a halfling neighborhood but leave other races untouched. What matters is the story you want to tell.

    Sample Diseases

    The diseases here illustrate the variety of ways disease can work in the game. Feel free to alter the saving throw DCs, incubation times, symptoms, and other characteristics of these diseases to suit your campaign.

    Ashen Inflammation

    Source 5e Horror (FGG)

    This disease is a mounting fever that eventually consumes its victims in fire. Those coming into contact with infected individuals, or the ash of the immolated victims must make a DC 13 Constitution saving throw or become infected. Creatures that do not breath receive advantage on this saving throw.

    The first symptoms of the disease appear in 1d4 + 1 hours, as the infected begin to develop a heavy fever and rash. The infected creature suffers 1 level of exhaustion; while the infected creature has at least 1 level of exhaustion they are also vulnerable to cold damage. At the end of each long rest, the infected creature must make a DC 15 Constitution saving throw. On a failure, they take 2 (1d4) fire damage for each level of exhaustion they possess and gain another level of exhaustion. On a success, they take no damage and lose a level of exhaustion. If the creature reaches level 6 of exhaustion, they burst into bright flame and then become a pile of loose ash. All creatures within 10 feet of the dying creature must make a DC 14 Dexterity saving throw or take 27 (5d10) fire damage on a failed save, or half as much damage on a successful one. Once the infected creature loses all levels of exhaustion, the disease ends.

    Blood Fever

    Source Vigil Watch Chapter One: The Toe Islands © 2020 Onyx Path Publishing

    Anyone consuming food or water contaminated by titan’s blood must make a DC 14 Constitution saving throw or suffer the effects of the ailment known as blood fever. Blood fever’s incubation period is 24 hours. When the incubation is complete, the victim reduces their hit point maximum by 5 (1d10), becomes poisoned until the disease is cured, and begins to convulse, literally sweating blood. The victim also hallucinates disturbing visions of violence and death. Every 24 hours that elapse, the infected must repeat the Constitution saving throw, reducing their hit point maximum by 5 (1d10) on a failure.

    This reduction to the creature’s hit point maximum lasts until the disease is cured. The disease is cured on a success. The victim dies if the disease reduces their hit point maximum to 0. A character that dies in this way rises as a blood fever zombie one day after death.

    Anyone who comes into physical contact with a victim of blood fever risks catching the disease as well, though the Constitution saving throw against contracting blood fever in this manner is DC 10. If a character makes a successful save, they are immune to contracting blood fever for 48 hours.

    Blood fever can be cured by a lesser restoration spell and other similar effects.


    Source 5e Horror (FGG)

    Wounds infected by poisonous spores wafting through the air of the jungle can carry dangerous toxins through the bloodstream, making it difficult to heal from injuries. When a creature is reduced to less than half of its hit points while inside of the jungle during the night, it must succeed on a DC 13 Constitution saving throw or become infected. It takes 2d4 hours for bloodmold’s symptoms to manifest in an infected creature. Symptoms include lightheadedness and disorientation. The infected creature only restores half as many hit points as normal from magical healing, when spending hit dice during a short rest, or after taking a long rest. At the end of each long rest, an infected creature must make a DC 13 Constitution saving throw. After 2 successful saving throws, the creature recovers from the disease.

    Cackle Fever

    This disease targets humanoids, although gnomes are strangely immune. While in the grips of this disease, victims frequently succumb to fits of mad laughter, giving the disease its common name and its morbid nickname: “the shrieks.”

    Symptoms manifest 1d4 hours after infection and include fever and disorientation. The infected creature gains one level of exhaustion that can’t be removed until the disease is cured.

    Any event that causes the infected creature great stress—including entering combat, taking damage, experiencing fear, or having a nightmare—forces the creature to make a DC 13 Constitution saving throw. On a failed save, the creature takes 5 (1d10) psychic damage and becomes incapacitated with mad laughter for 1 minute. The creature can repeat the saving throw at the end of each of its turns, ending the mad laughter and the incapacitated condition on a success.

    Any humanoid creature that starts its turn within 10 feet of an infected creature in the throes of mad laughter must succeed on a DC 10 Constitution saving throw or also become infected with the disease. Once a creature succeeds on this save, it is immune to the mad laughter of that particular infected creature for 24 hours.

    At the end of each long rest, an infected creature can make a DC 13 Constitution saving throw. On a successful save, the DC for this save and for the save to avoid an attack of mad laughter drops by 1d6.

    When the saving throw DC drops to 0, the creature recovers from the disease. A creature that fails three of these saving throws gains a randomly determined form of indefinite madness.

    Calcification Virus

    Source 5e Horror (FGG)

    This virus slowly turns the victim’s bodily fluids into a solid calcified substance. Sufferers typically suffocate on their own blood well before their blood completely calcifies. As the body decomposes, fluids calcify as well, until the body turns into bones and dust.

    The dust carries the disease and can become infectious if breathed in or ingested. Creatures exposed to the disease must make a DC 14 Constitution saving throw or become infected.

    Within a day, the victim begins to feel pain and fatigue. After 3 days, the creature begins to develop rough patches over the skin that feel hard and thick.

    At this stage, the creature has disadvantage on Constitution checks (but not saving throw). After 8 days, the creatures become blind and develops stiff joints, gaining disadvantage on Dexterity checks, as well as reducing their movement speed by half.

    After 18 days the infected creature must make a DC 12 Constitution saving throw every hour or begin to suffocate. There is no cure for the crystal virus.

    Creatures suffering from the disease remain infected until the disease is cured with magic or they die.

    Curiously, if an infected creature has their shape changed, they may attempt another save to end the disease when they return to their original form.

    Green Decay

    Source SPCM

    The flesh of a creature that has this disease is slowly consumed by a virulent extraterrestrial fungus. While the disease persists, the creature has disadvantage on Charisma and Wisdom checks and on Wisdom saving throws, and it has vulnerability to acid, fire, and necrotic damage. An affected creature must make a Constitution saving throw at the end of each of its turns. On a failed save, the creature takes 1d6 necrotic damage, and its hit point maximum is reduced by an amount equal to the necrotic damage taken. If the creature gets three successes on these saving throws before it gets three failures, the disease ends immediately (but the damage and the hit point maximum reduction remain in effect). If the creature gets three failures on these saving throws before it gets three successes, the disease lasts for the duration of the spell, and no further saving throws are allowed.

    Marblewife Syndrome

    Source 5e Horror (FGG)

    Though some legends tell of master crafters creating lovers out of stone, this disease was named for such a fable. The disease turns its victims to stone and can be contracted by a not yet petrified victim, as well as during “spore” seasons in which the petrified victim gives off a fungal-like shedding that can further affect other creatures. These seasonal spores complicate attempts to unpetrify victims, which often leads to the destruction or entombment of victims that might otherwise be cured.

    After physical contact with an infected creature, a victim must succeed on a DC 12 Constitution saving throw or become infected. If an infected statue is sporing, a creature that comes within 20 feet of the statue must make the same saving throw. Sporing statues are covered with a flaky substance that resembles dried paint.

    A victim begins to lose points from their Dexterity score at the rate of 2d4 per 24 hour period. If this results in a Dexterity score of 1 or less, the victim becomes petrified. Any means of unpetrifying the victim will also remove the disease, and infected individuals also can benefit from either any means that remove disease or that remove the petrified condition, both of which cure the infected.

    There are dreaded tales of entire cities succumbing to this disease, drawing in the curious and the greedy, only to add to the grim menagerie of lifelike statues.

    Marrow Ooze

    Source 5e Horror (FGG)

    Though not technically a disease, the marrow ooze parasite nonetheless infects its victims with its presence. A marrow ooze enters the body through a wound or exposed orifice (potentially the mouth or ears) while the victim is sleeping, and begins to consume the host’s marrow. The victim can make a DC 13 Constitution saving throw to resist the infection.

    On a success, the marrow ooze escapes avoiding being destroyed by the host’s immune system. On a failure, the host is infected but actually feels better than ever. Infected creatures begin to look more attractive, and are healed of any bone deformities, bone conditions, or diseases of the blood.

    Each day thereafter, an infected creature must make a DC 13 Constitution saving throw. On a failure, the host reduces their hit point maximum by 10, to a minimum of 1. Once the host has reached this minimum, the marrow ooze splits and horrifically transforms the host’s limbs into new marrow oozes in a process that resembles the melting of a piece of wax. The host is left without limbs, but their hit point maximum is restored.

    These victims are at increased risk of developing a traumatic insanity.

    A host that succeeds at two saving throws (they need not be consecutive) can expel the creature, though the expulsion process is painful and difficult.

    Once the expulsion process begins, the host begins to bleed from every orifice and loses body fluids through violent and frequent body emissions.

    This process reduces deals 2d6 piercing and 2d6 poison damage unless the host receives proper medical care (requiring a DC 15 Wisdom (Medicine) check). If a victim should die due to this violent process, their insides are liquefied, and 1d2 marrow oozes emerge from the body.

    Risen Sickness

    Source 5e Horror (FGG)

    Among all disease, few are as feared as risen sickness. Fabled to have toppled empires, this sickness creates undead with staggering efficiency, and at the least ensures a culture of fear and paranoia.

    Even the rumor of risen sickness is enough to rally mobs to stamp it out, and kings have been known to wipe out entire communities as a safety measure, whether it was merited or not.

    What is not certain is how the disease starts, but when it does, corpses begin to rise and hunger for flesh. This disease often spreads to long-dead corpses who have no resistance to the disease whatsoever, and swell the ranks of the risen.

    Walking corpses are considered zombies, replacing their slam attack with a bite attack that imparts the infection (+3 to hit, 5 ft. reach, one target, 1d4+1 piercing damage). These corpses infect their victims with a disease that kills and raises even more walking corpses. An individual exposed to a bite must make a DC 17 Constitution saving throw. Failure means the victim is infected. After every hour of infection, the infected creature loses 2d6 hit points from their maximum. If this maximum reaches zero, the infected creature dies and rises as a zombie within 1 minute of death.

    There is no simple cure for this disease outside of magic, though there are special herbs that can remove the infection before death. An infected victim that is cured is also restored to their normal hit point maximum. There are rumors of random individuals that are naturally immune to the disease, though such tales also say that the immune are carriers, and unwittingly help the spread of the disease.

    Rosen Doom

    Source 5e Horror (FGG)

    The disease known as rosen doom is identified by the haunting reddish hue that affected corpses take on. The blood of the deceased victims also remains a strange reddish color even decades after their death, partially preserving corpses, and retaining the virulence of the disease for just as long.

    This disease is primarily spread through contact with infected blood, although any bodily fluid can transfer the disease. A creature that makes contact with such a fluid must make a DC 16 Constitution saving throw, becoming infected on a failure.

    Symptoms develop within 1d4 days. Infected creatures suffer 1 level of exhaustion. While exhausted, the creature coughs blood and develops weeping sores across their body. At the end of each long rest, the creature must make a DC 16 Constitution saving throw, taking 11 (2d6) necrotic damage on a failure and gaining 1 level of exhaustion.

    On a successful save, the DC of the saving throw is reduced by 1d4+1. When the saving throw DC becomes 0, the disease ends.

    Sewer Plague

    Sewer plague is a generic term for a broad category of illnesses that incubate in sewers, refuse heaps, and stagnant swamps, and which are sometimes transmitted by creatures that dwell in those areas, such as rats and otyughs.

    When a humanoid creature is bitten by a creature that carries the disease, or when it comes into contact with filth or offal contaminated by the disease, the creature must succeed on a DC 11 Constitution saving throw or become infected.

    It takes 1d4 days for sewer plague’s symptoms to manifest in an infected creature. Symptoms include fatigue and cramps. The infected creature suffers one level of exhaustion, and it regains only half the normal number of hit points from spending Hit Dice and no hit points from finishing a long rest.

    At the end of each long rest, an infected creature must make a DC 11 Constitution saving throw. On a failed save, the character gains one level of exhaustion. On a successful save, the character’s exhaustion level decreases by one level. If a successful saving throw reduces the infected creature’s level of exhaustion below 1, the creature recovers from the disease.

    Shadowed Typhus

    Source 5e Horror (FGG)

    This magical illness infects a victim’s shadow, causing the victim to slowly become a dark shade.

    This diseases may be contracted if an infected creature stands in your shadow, or by lurking in the same shadow as an infected creature. Creatures of the outsider and aberration type are immune to the effects of the disease, but may still carry and transmit the disease to others.

    Symptoms develop the sunset after contraction.

    At that time, the victim begins feeling weak, and their shadow appears darker than usual. The victim begins to fear any light and feels pain and anguish if exposed to sunlight (this exposure does not cause any physical harm). The creature must make a DC 15 Constitution check to willingly step into any bright light.

    If allowed to linger in the shadows, the disease worsens, and the infected creature begins to look as though they are in the shadows even when in the light. After three days without exposure to any bright light, the creature begins a transformation into shadow that takes place from sunset to dawn after the third day of prolonged darkness. The infected creature becomes a shadow that is able to create other shadows through disease rather than by its strength drain ability (which otherwise remains unchanged).

    The only cure for this disease is prolonged exposure to sunlight (1 uninterrupted hour), radiant damage (equal to half of maximum hit points), or a lesser restoration. Spells and abilities that remove curses or diseases will also end this disease.

    Sight Rot

    This painful infection causes bleeding from the eyes and eventually blinds the victim.

    A beast or humanoid that drinks water tainted by sight rot must succeed on a DC 15 Constitution saving throw or become infected. One day after infection, the creature’s vision starts to become blurry. The creature takes a ?1 penalty to attack rolls and ability checks that rely on sight. At the end of each long rest after the symptoms appear, the penalty worsens by 1. When it reaches ?5, the victim is blinded until its sight is restored by magic such as lesser restoration or heal.

    Sight rot can be cured using a rare flower called Eyebright, which grows in some swamps. Given an hour, a character who has proficiency with an herbalism kit can turn the flower into one dose of ointment. Applied to the eyes before a long rest, one dose of it prevents the disease from worsening after that rest. After three doses, the ointment cures the disease entirely.

    Slimy Doom (3pp)

    Slimy Doom is caught from contact with the remains of a creature that dies of Tsathoggan Rotting Disease. For each round of contact with dissolved flesh of such a victim, a creature must succeed on a DC 16 Constitution saving throw or succumb to the disease with no initial incubation period. Slimy doom turns a person into goo from the inside out. Each day, the victim must pass a DC 16 Constitution saving throw or lose 1d4 points of their Constitution. At 0 Constitution, they are nothing more than a fleshy bag of pus and bloody foam. Those who are cured by spell or who pass two daily saving throws in a row, must make one additional saving throw for each day they took Constitution damage. If these saving throws fail, the victim has permanently lost a point of Constitution per failed saving throw.

    Stomach Parasites

    Source 5e Horror (FGG)

    Invisible to the naked eye, travelers know better than to drink from waters deep in the wilderness for fear of ingesting these stomach parasites. When a creature drinks or otherwise consumes water contaminated by parasites, the creature must succeed on a DC 12 Constitution saving throw or become infected. It takes 1d4 days for symptoms of a stomach parasite to manifest in an infected creature. Symptoms include stomach cramps, taut skin, and extreme muscle definition. Every week, the infected creature doubles the amount of food and water it needs to survive. An infected creature that does not receive enough sustenance regains no healing from short or long rests. A creature can cure the disease with a greater restoration, or an attack or spell that deals 10 points of force damage per week of infection.


    Source 5e Horror (FGG)

    A strange and unusual condition, telepathitis is transmitted by mental contact with an infected creature, or more rarely through physical contact with brain tissue. Such contact requires a DC 13 Constitution save if physical contact is made, or a DC 11 Wisdom save if mental contact is made. Failure results in infection.

    A creature so infected can begin to read thoughts, but does so erratically, gleaning surface thoughts from any nearby creatures. Through mental strain, an infected creature can hone the ability and listen to specific thoughts, as per the spell detect thoughts. They can only use this ability once and regain the ability to do so after each long rest.

    However, this and other mental stressors cause the disease to worsen, and they begin to deteriorate. An infected victim gains an exhaustion level each time they strain to use their ability to detect thoughts and gain an additional exhaustion level if they read the thoughts of a creature with an intelligence score of 18 or higher.

    The infected creature also gains a level of exhaustion if they are around a crowd of 10 or more for more than a minute. With each level of exhaustion gained, the infected suffers from a headache of increasing intensity.

    When the infected creature reaches 6 levels of exhaustion, their head explodes and they die. This can only be prevented by prolonged sensory deprivation and rest. The infected creature cannot have any levels of exhaustion nor be exposed to any thoughts for a minimum of 3 days. If such conditions are met, they are no longer infected.

    Curiously, creatures that resemble brains are susceptible to this disease, which displays more as a wasting cancerous condition. Intellect devourers, grell, and brain consuming creatures are likely vectors for this disease, which sometimes mercifully thins their populations.

    Terror Plague

    Source 5e Horror (FGG)

    Called by some the “rabid fear”, this disease attacks the mind and is spread through bodily fluids, most commonly by sweat. Victims begin to see hallucinations of their darkest fears, often attacking others and spreading infection in an addled attempt to fight off the visions of terror.

    A victim exposed to the body fluids of an infected must make a DC 12 Constitution save or become infected.

    Onset happens during the first evening of infection, and symptoms manifest as visions of dangerous and deadly creatures or hazards, or often the subject of the victim’s phobias or self-doubts. Once these visions begin, the victim sweats profusely, to the point that they drip with sweat. Infected creatures are unable to sleep or rest, and gain no benefits from a short or long rest other than staving off exhaustion. Prolonged infection might result in long-term madness (see madness rules).

    One cure for this disease is to gouge one’s eyes out. Though not a popular cure, it can be a necessary one to stave off madness and sleep deprivation.

    This does not so much cure the disease as it prevents the symptoms, and the victim can still transmit the disease to others (though they do not suffer from the heavy sweat that the visions induce). The only other non-magical cure must be procured from the blood of a hag and requires a DC 20 Wisdom (Medicine) check to properly distill into a working cure. Whatever the connection between hags and this disease may be, it only serves to make each all the more terrifying.

    Tinea Cruris

    Source 5e Horror (FGG)

    Wearing one’s armor too long and going without washing has its consequences in humid environments. When a creature has gone a week without bathing or more than 3 days without cleaning a suit of armor they wear each day, the creature must succeed on a DC 8 Constitution saving throw or become infected. It takes 2d6 days for tinea cruris symptoms to manifest in an infected creature. Symptoms include itching and odor in the groin. The infected creature emits a stench that gives it disadvantage on Charisma ability checks made against creatures within 10 feet. Every week, the infected makes a Constitution saving throw (DC 8 + 1 per previous save) or the range of its stench increases by 5 feet (to a maximum of 20 feet). After 5 successful saving throws the creature recovers from the disease. Whenever the adventurers uncover a new part of the map, the GM chooses from or rolls on the following tables to generate what they find: two geographical areas, two inhospitable terrains, and one warlord.


    In a typical campaign, characters aren’t driven mad by the horrors they face and the carnage they inflict day after day, but sometimes the stress of being an adventurer can be too much to bear. If your campaign has a strong horror theme, you might want to use madness as a way to reinforce that theme, emphasizing the extraordinarily horrific nature of the threats the adventurers face.

    Going Mad

    Various magical effects can inflict madness on an otherwise stable mind. Certain spells, such as contact other plane and symbol, can cause insanity, and you can use the madness rules here instead of the spell effects of those spells. Diseases, poisons, and planar effects such as psychic wind or the howling winds of Pandemonium can all inflict madness. Some artifacts can also break the psyche of a character who uses or becomes attuned to them.

    Resisting a madness-inducing effect usually requires a Wisdom or Charisma saving throw.

    Madness Effects

    Madness can be short-term, long-term, or indefinite. Most relatively mundane effects impose short-term madness, which lasts for just a few minutes. More horrific effects or cumulative effects can result in long-term or indefinite madness.

    A character afflicted with short-term madness is subjected to an effect from the Short-Term Madness table for 1d10 minutes.

    A character afflicted with long-term madness is subjected to an effect from the Long-Term Madness table for 1d10 × 10 hours.

    A character afflicted with indefinite madness gains a new character flaw from the Indefinite Madness table that lasts until cured.

    Table: Short-Term Madness
    d100 Effect (lasts 1d10 minutes)
    01–20 The character retreats into his or her mind and becomes paralyzed. The effect ends if the character takes any damage.
    21–30 The character becomes incapacitated and spends the duration screaming, laughing, or weeping.
    31–40 The character becomes frightened and must use his or her action and movement each round to flee from the source of the fear.
    41–50 The character begins babbling and is incapable of normal speech or spellcasting.
    51–60 The character must use his or her action each round to attack the nearest creature.
    61–70 The character experiences vivid hallucinations and has disadvantage on ability checks.
    71–75 The character does whatever anyone tells him or her to do that isn’t obviously self-­ destructive.
    76–80 The character experiences an overpowering urge to eat something strange such as dirt, slime, or offal.
    81–90 The character is stunned.
    91–100 The character falls unconscious.
    Table: Long-Term Madness
    d100 Effect (lasts 1d10 × 10 hours)
    01–10 The character feels compelled to repeat a specific activity over and over, such as washing hands, touching things, praying, or counting coins.
    11–20 The character experiences vivid hallucinations and has disadvantage on ability checks.
    21–30 The character suffers extreme paranoia. The character has disadvantage on Wisdom and Charisma checks.
    31–40 The character regards something (usually the source of madness) with intense revulsion, as if affected by the antipathy effect of the antipathy/sympathy spell.
    41–45 The character experiences a powerful delusion. Choose a potion. The character imagines that he or she is under its effects.
    46–55 The character becomes attached to a “lucky charm,” such as a person or an object, and has disadvantage on attack rolls, ability checks, and saving throws while more than 30 feet from it.
    56–65 The character is blinded (25%) or deafened (75%).
    66–75 The character experiences uncontrollable tremors or tics, which impose disadvantage on attack rolls, ability checks, and saving throws that involve Strength or Dexterity.
    76–85 The character suffers from partial amnesia. The character knows who he or she is and retains racial traits and class features, but doesn’t recognize other people or remember anything that happened before the madness took effect.
    86–90 Whenever the character takes damage, he or she must succeed on a DC 15 Wisdom saving throw or be affected as though he or she failed a saving throw against the confusion spell. The confusion effect lasts for 1 minute.
    91–95 The character loses the ability to speak.
    96–100 The character falls unconscious. No amount of jostling or damage can wake the character.
    Table: Indefinite Madness
    d100 Flaw (lasts until cured)
    01–15 “Being drunk keeps me sane.”
    16–25 “I keep whatever I find.”
    26–30 “I try to become more like someone else I know—adopting his or her style of dress, mannerisms, and name.”
    31–35 “I must bend the truth, exaggerate, or outright lie to be interesting to other people.”
    36–45 “Achieving my goal is the only thing of interest to me, and I’ll ignore everything else to pursue it.”
    46–50 “I find it hard to care about anything that goes on around me.”
    51–55 “I don’t like the way people judge me all the time.”
    56–70 “I am the smartest, wisest, strongest, fastest, and most beautiful person I know.”
    71–80 “I am convinced that powerful enemies are hunting me, and their agents are everywhere I go. I am sure they’re watching me all the time.”
    81–85 “There’s only one person I can trust. And only I can see this special friend.”
    86–95 “I can’t take anything seriously. The more serious the situation, the funnier I find it.”
    96–100 “I’ve discovered that I really like killing people.”

    Sample Madness Afflictions

    All of the following samples are from the same 3pp source (TGP


    It’s not an irrational fear of heights if it keeps you alive…

    Short. You have disadvantage on Strength and Dexterity skill checks involving heights.

    Long. You cannot climb or fly more than 10 feet above the ground unless you succeed on a DC 15 Wisdom saving throw.

    Indefinite. “I know I’ll die from a bad fall.”


    Memories are like glass, so easily shattered…

    Short. You cannot distinguish enemies from allies and must use your action to attack the closest creature each round.

    Long. You don’t recognize other people or remember anything from before this madness took effect.

    Indefinite. “I’ve forgotten friends, foes, and facts from before this affliction took me.”


    Magic corrupts and kills…

    Short. You cannot cast spells, use magical items, or be a wilful target of a spell.

    Long. You must succeed on a DC 15 Wisdom saving throw to cast a spell or attune to a magical item.

    Indefinite. “Magic contaminates, I distrust it.”

    Bestial Mind

    In the mind of every man lurks a beast that won’t be chained…

    Short. You cannot cast spells and can only make unarmed attacks.

    Long. When you deal damage, you must succeed on a DC 15 Wisdom saving throw or keep attacking that creature until it is destroyed.

    Indefinite. “The moon answers my howls.”


    The walls are closing in…

    Short. You become frightened of any space smaller than 5-feet wide.

    Long. You cannot pass through spaces smaller than 3-feet wide unless you succeed on a DC 15 Wisdom saving throw.

    Indefinite. “I hate enclosed spaces.”


    The nagging lust for human flesh consumes your mind…

    Short. You must use your action each turn to make melee attacks against the closest humanoid enemy.

    Long. When you eat anything other than fresh raw humanoid meat you are poisoned for 1 hour.

    Indefinite. “I enjoy the taste of human flesh.”


    The world is a strange place…

    Short. You are stunned.

    Long. When you fail a saving throw, you must succeed on a DC 15 Wisdom saving throw or are stunned until the end of your next round.

    Indefinite. “Very little makes sense to me.”

    Delusions of Grandeur

    It’s great to be a god…

    Short. Give your allies an order. The GM may decide if the task is sufficient or not. You are poisoned until your allies have completed the task.

    Long. You expect protection. When you take damage from a source within 5 feet of an ally, you become stunned until the end of your next turn.

    Indefinite. “They must follow my every command.”


    Society’s norms are a shackle…

    Short. Your alignment changes to the opposite of your party’s average alignment.

    Long. As above, and you have disadvantage on Charisma based skill checks involving lawfully aligned creatures.

    Indefinite. “Rules are meant to be broken.”

    Dissonant Whispers

    The voices whisper eldritch secrets…

    Short. You are deafened by the voices in your head.

    Long. You have disadvantage on Wisdom (Perception) checks involving listening.

    Indefinite. “The voices inside my head tell me terrible truths.”


    The bottle is your only refuge…

    Short. You are poisoned until you drink alcohol.

    Long. When you finish a long rest, lose 1d10 silver pieces and you are poisoned for 1d4 hours unless you succeed at a DC 15 Constitution saving throw.

    Indefinite. “Being drunk keeps me sane.”

    Fear of the Dark

    The dark is an impenetrable shroud

    Short. Dim light counts as darkness for you and your darkvision doesn’t function.

    Long. Dim light that is not adjacent to a bright light counts as darkness for you and your darkvision doesn’t function.

    Indefinite. “I’m as blind as a bat after the sun sets.”


    You’ll get lucky, this time…

    Short. You take unnecessary risks, resulting in a –2 penalty to your AC.

    Long. When you take a long rest in an urban area, roll 1d6. On a 1–4, lose 2d10 gold pieces. On a 5–6, gain 2d10 gold pieces.

    Indefinite. “There’s no bet I can’t win.”


    The dead have come to call…

    Short. Enemies that died within the last ten minutes come to life as spectres with 1d4 hit points. Undead and constructs are not affected.

    Long. You see ghostly shadows on your periphery. You have disadvantage on Wisdom (Perception) checks involving sight.

    Indefinite. “The dead surround me like ghostly shadows.”


    Blood is a disgusting, staining thing…

    Short. You are stunned until the end of your next turn if an ally within 30 feet takes piercing or slashing damage.

    Long. You have disadvantage on Wisdom (Medicine) checks to stabilize dying creatures.

    Indefinite. “I faint at the sight of blood.”


    Only blood will wash away this rage…

    Short. You must use your action each turn to attack an enemy with a melee attack.

    Long. You must attack the closest enemy unless you succeed on a DC 15 Wisdom saving throw. You cannot knock creatures unconscious.

    Indefinite. “I love killing more than anything.”


    Abandon hope all ye who enter here…

    Short. You are frightened of the cause of this madness.

    Long. You have disadvantage on Wisdom saving throws.

    Indefinite. “There is no hope.”


    There’s no rest for you now…

    Short. You are immune to sleep effects and cannot take a short or long rest.

    Long. You must succeed on a DC 15 Constitution saving throw or gain a level of fatigue whenever you take a long rest.

    Indefinite. “There are more horrors in my dreams, so I stay awake.”


    So much wealth, ripe for the picking…

    Short. While you are not in melee range of an enemy, you must spend your actions looting.

    Long. When you take a long rest, you must succeed on a DC 15 Wisdom saving throw or attempt to steal from a random ally.

    Indefinite. “I take whatever I can.”


    The pain is exhilarating…

    Short. You cannot wilfully accept healing or heal yourself.

    Long. You have a –2 penalty to AC unless you are not wearing armour.

    Indefinite. “Pain reminds me that I’m alive.”


    The walls have ears…

    Short. You mumble incoherently. You have disadvantage on Charisma based skill checks and can’t cast spells with a verbal component.

    Long. You have a –2 penalty on Charisma based skill checks that require you to speak.

    Indefinite. “They would hear me if they paid attention.”


    Nowhere to run, nowhere to hide

    Short. Other creatures can’t use the Help action to aid you and you can’t accept potions from allies.

    Long. You can’t reduce your levels of exhaustion below level 1 when you finish a long rest. You gain a +2 bonus on Wisdom (Perception) checks.

    Indefinite. “My enemies are everywhere. I trust no one and no thing.”


    Fire! Fire, fire, FIRE!

    Short. You can only make attacks with weapons and spells that deal fire damage.

    Long. When you deal fire damage, creature within 5 feet of you must succeed on a DC 15 Dexterity saving throw or take 1d6 fire damage.

    Indefinite. “Fire will burn away all sorrow.”


    A fractured mind sees many strange reflections…

    Short. You are affected as though you failed a saving throw against the confusion spell.

    Long. When you take damage, you must succeed on a DC 15 Wisdom saving throw or suffer the effect above for 1 minute.

    Indefinite. “Many faces define me; I’m always presenting a different one.”


    It is yours, by right…

    Short. You must use your action each turn to acquire as much wealth as possible.

    Long. You cannot cast beneficial spells or give items to other creatures unless you first succeed on a DC 15 Wisdom saving throw.

    Indefinite. “It is all mine!”



    Short. You can only make bite attacks, which count as unarmed strikes that deal piercing damage equal to 1 + your Strength modifier.

    Long. When you drop a creature to 0 hp with a melee attack, you begin feeding on it and are restrained until the end of your next turn.

    Indefinite. “I crave fresh blood from the living.”

    Curing Madness

    A calm emotions spell can suppress the effects of madness, while a lesser restoration spell can rid a character of a short-term or long-term madness. Depending on the source of the madness, remove curse or dispel evil might also prove effective. A greater restoration spell or more powerful magic is required to rid a character of indefinite madness.