Skip to main content


Mental Stress Effects

Adventurers encounter and even seek out experiences beyond the ken of most mortals. Whether it’s harrowing encounters with interdimensional beings, the sudden, violent loss of a beloved NPC, or simply the trauma of constantly being surrounded by death and terror, their lows can be as dramatic and potentially impactful as their highs. 

The harm that can come to adventurers may not always be physical, and players may decide that these events have a more lasting effect on their character’s psyche. It’s important to consider this in conjunction with the safety rules and its potential impact on the game. When a group or the Narrator decides that gamifying mental stress and morale isn’t right for the campaign, respectful roleplay is a viable alternative to these mechanics.           

Mental Stress Effects

The Narrator may decide that a particular encounter that goes badly can leave a lasting impact on adventurers. Alternatively, if these options are discussed during character creation a player may decide that an event in their past provides sufficient mental stress to bring about a change in their character. These effects provide options for short- and long-term repercussions. A creature may only have one mental stress effect at a time. A long-term effect overrides a short-term effect, and if two effects are of equal strength, the most recent effect replaces the older effect.

A mental stress effect is usually best chosen based on the encounter that causes it and an adventurer’s personality, but may be randomly determined using the mental stress effect tables.

Table: Short-Term Mental Stress Effects (d10)

  1. Bewildered

  2. Cowed

  3. Distraught

  4. Enraged

  5. Flippant

  6. Musical

  7. Obsessed

  8. On Edge

  9. Sleepless

  10. Terrorized

Table: Long-Term Mental Stress Effect (d10)

  1. Covetous

  2. Distorted perceptions

  3. Hopeless

  4. Inimical

  5. Memory Wipe

  6. Murderous

  7. Peacekeeping

  8. Phobia

  9. Superstitious

  10. Suspicious

Strife and Mental Stress Effects

When a creature suffers its fifth level of strife it gains a short-term mental stress effect, and when it suffers its seventh level of strife it gains a long-term mental stress effect.

Short-Term Mental Stress Effects

These conditions are the immediate effects of mental stress after an event or encounter. They last for 1d6 days, but could remain longer based on discussions between the Narrator and player. 


A bewildered creature is overwhelmed by trying to process a particular event. Its mind begins to play tricks, altering its perceptions. A bewildered creature has disadvantage on social-based ability checks as it struggles to engage with what’s happening. When a bewildered creature would succeed on an ability check, roll another d20. On a result of 15 or less the creature succeeds, but otherwise it fails the ability check instead. This could be caused by a temporary forgetfulness that leads the creature to forget what it was trying to achieve, or in some cases a brief hallucination that alters the circumstances in such a way that it is unable to succeed.


A cowed creature cannot shake the idea that they are certain to face defeat, and so flinch and surrender at the first sign of danger. After taking any damage in combat, on its next turn a cowed creature takes the Dash action and uses all of its movement to escape danger (or if it is unable to move towards safety, the Dodge action). A cowed creature has disadvantage on Intimidation checks and when given any alternative to combat will happily take it, and it has advantage on Persuasion checks made to try and avoid combat.


A distraught creature is visibly and deeply shaken by a recent experience, and its apparent distress moves people to do what they can to help. Once per long rest, a distraught creature can choose to gain advantage on a check made to persuade neutral or friendly creatures to aid it, but it has disadvantage on Deception, Performance, and initiative checks.


An enraged creature is unable to shake its frustration with an enemy or its own perceived failings after an encounter. An enraged creature has advantage on Strength checks, but has disadvantage on all other ability checks. Whenever an enraged creature fails an ability check, it throws or attempts to break any tools or objects involved in the check.


A flippant creature refuses to face the enormity of whatever event befell it. Not only does a flippant creature superficially shrug off the experience, it goes to reckless ends to prove it is ‘unaffected’ with little regard for itself or allies. A flippant creature has advantage on Dexterity checks, but has disadvantage on Wisdom checks and saving throws .


A musical creature has temporarily taken leave of social norms after a deep shock or strange encounter. Instead of talking, it now sporadically sings its thoughts and during conversation, giving it disadvantage on Deception, Intimidation, and Stealth checks but advantage on Performance checks.


An obsessed creature cannot stop talking about the ordeal that troubles it. It has disadvantage on Stealth checks as it constantly tells allies that it is reminded of “that time when…” Whenever initiative is rolled, an obsessed creature makes a DC 15 Wisdom saving throw or loses 1 round of actions as it wrestles with and exclaims about the similarities to the traumatic encounter in its past.


A creature that is on edge is hyperaware of its surroundings and unable to fully relax. An on edge creature has advantage on Perception and initiative checks, but disadvantage on all other ability checks as it is distracted, unable to take its mind off the dangers that could potentially lurk around every corner.


A sleepless creature is unsettled by its encounter and struggles to relax in order to sufficiently rest. Whenever a sleepless creature takes a long rest, it makes a DC 15 Wisdom saving throw to quiet its mind or only gains the benefits of a short rest . During rests where a sleepless creature has failed its Wisdom save, it has advantage on Perception checks made to detect danger.


A terrorized creature is not just fearful of danger but convinced it is already here. A terrorized creature is unable to shake its fear response from its unsettling encounter, unwilling to go within 30 feet of strangers or participate in melee combat without succeeding on a DC 15 Wisdom saving throw first (instead taking the Dash action to escape to safety or retreat from a sudden noise). A terrorized creature has advantage on Perception checks and any Strength, Dexterity, or Constitution checks made to escape combat or danger, but it will sleep only in places with reasonable security precautions.

Long-Term Mental Stress Effects

These effects denote a more permanent impact made by the mental stress of traumatic encounters. 


A covetous creature is gripped by a fear of losing in any sense and it begins to desire what is owned by others, no matter how small or seemingly insignificant, feeling deprived by that which they do not have. A covetous creature has advantage on Sleight of Hand checks, but disadvantage on Wisdom saving throws and Deception checks related to things it has taken.


A creature with distorted perceptions has been shaken to its core, and perhaps had its mind jolted by interdimensional travel. Whenever a creature with distorted perceptions rolls a Perception check with a result equal to or less than its passive Perception, small details of the world begin to warp—a swaying tree becomes a dancing shadowy figure, a coil of rope becomes a deadly snake coiled to attack, and its allies may temporarily wear the face of an enemy. These distorted perceptions are brief but absolutely real to the creature. 

Discussion between the Narrator and the player of an adventurer with distorted perceptions can determine what kind of hallucinations they’re most likely to have and how far they’d like to take it.


A hopeless creature has completely lost faith in its purpose and finds it difficult to be motivated. A hopeless creature has advantage on Persuasion checks that involve convincing someone not to take a certain course of action, arguing the pointlessness of it all, but it has disadvantage on initiative checks.


When an inimical creature is bloodied , on its next turn it takes the Attack action against the nearest creature to it. The inimical creature has disadvantage on these attacks as it flails without control. In addition, an inimical creature has disadvantage on checks and saving throws[[ made against being [[grapple or restrained .


A creature with a memory wipe becomes forgetful in the extreme after its encounter, perhaps not remembering the event at all. A memory wiped creature has disadvantage on Arcana, Culture, History, Nature, and Religion checks, and any other knowledge-based check as its capacity to easily recall information is profoundly affected.


A murderous creature no longer sees shades of gray when it comes to even the gentlest disagreement or conflict. At the first sign of conflict, whether that be disagreement within the party or a suspicious looking stranger, a murderous creature sees red, attacking first and asking questions later. Dazed by their recklessness, a murderous creature has disadvantage on initiative checks, but advantage on its first attack roll on each of its turns while in such a state. This state lasts for a maximum of 5 rounds, but can be ended earlier by a calm emotions spell or DC 18 Persuasion check. 


A peacekeeping creature wants no more violence and on each of its turns uses all of its actions to prevent or subdue combat by every nonviolent method at its disposal, continuing this course of action until it or an ally are bloodied . A peacekeeping creature has disadvantage on initiative checks but advantage on its first ability check made to try and end a combat.


A traumatic encounter leads a creature to have a long-term, debilitating fear of some element of the encounter. For example, narrowly escaping a burning building may leave a creature with a phobia of fire. When encountering the subject of its phobia, a creature makes a DC 18 Wisdom saving throw . On a success the creature can act normally, but on a failure it is frightened for 1 minute (at the Narrator’s discretion, depending on the situation it may be incapacitated instead). At the end of each of its turns, the creature repeats the saving throw, able to act normally on a success.


A creature comes to believe it has survived its traumatic encounter thanks only to the presence of a lucky charm. This charm can be anything it had on its person at the time of the event. The superstitious creature has disadvantage on attack rolls and saving throws whenever it is more than 30 feet away from its charm, except for Investigation or Perception checks to find the charm again (which are made with advantage ).


A suspicious creature has lost faith in the goodness of the people and circumstances around it. A suspicious creature has advantage on Sleight of Hand checks, and Perception checks to detect hidden foes, but it has disadvantage on Insight checks as it is unable to objectively interpret intentions. 

Indefinite Mental Stress

It may be that a creature encounters a situation that inflicts indefinite effects on its psyche. In this case it may have one or more of any of the above mental stress effects, with no time limits imposed. The Narrator should decide which effects and how many. A creature can only suffer from multiple mental stress effects if one or more are indefinite mental stress effects.

Saving Throws

Saving throws can be used to determine how a creature handles the mental stress of a particular encounter. When a creature fails a saving throw by 10 or more or rolls a critical failure on a saving throw, it may acquire a short-term mental stress effect determined by what the save was made for. In a tougher encounter, at the Narrator’s discretion a success may mean that a creature is left with a short-term mental stress effect, and on a failure it instead acquires a long-term mental stress effect.

Wisdom or Charisma saving throws are most likely to relate to a creature’s mental fortitude, however Intelligence or Constitution may be more applicable based on the encounter.

Spell Effects

Some spells such as contact other plane and symbol involve potential impacts on the mind of a creature. Rather than using the described spell effects, the Narrator may substitute a short- or long-term mental stress effect.

Relieving Mental Stress Effects

Like physical injuries, the mental impacts of adventuring are not permanent. In a world where even death is not necessarily the end, there are also options to recover from the mental impacts of overwhelming events.


In the same way that danger sometimes passes without combat, conditions that impact an adventurer’s psyche (rather than their physical self) can be resolved through effective roleplay. Roleplaying an important resolution for a PC (or even an important NPC) may bring an end to their condition—this might be reuniting with a significant person from their past, finally defeating a sworn enemy, or simply being soothed by the companionship and protection of their allies. 

Healing Magic

Short- and long-term mental stress effects can usually be removed with a greater restoration spell (although the Narrator may set other conditions) and temporarily relieved by the calm emotions spell (until the spell ends).

Other Magic. The obvious restorative properties of healing magic are effective, but powerful illusions or even spells that alter reality have the potential to end mental stress effects.

Personality Changes

A failed saving throw may not lead to a mental stress effect. In some cases after discussion with the group, the Narrator may decide that a particular event leads to a far more fundamental change. The nature of this change and the status of an adventurer’s mental stress effect afterward (it may become a long-term mental stress effect, indefinite, change to a short-term mental stress effect, or be removed entirely) are at the Narrator’s discretion.