Fear, Horror, and Madness saves represent the power of terror The GM can always consider these saving throws optional. If a player portrays the stark terror of her hero without prompting, no die roll is necessary. Note: Creatures without Intelligence scores are immune to Fear, Horror, and Madness effects.

Making the Saving Throw:
Fear, Horror, and Madness saves are considered Will saves in all respects. Anything that modifies a Will save likewise modifies Fear, Horror, and Madness saves; anything that modifies saves vs. fear effects modifies Fear saves. Fear, Horror, and Madness saves all use the same basic mechanic: a Will save against a specified DC. Specific DCs depend on the situation and type of check being made and are provided in the following sections. Luck effects and resistance effects do not affect Fear, Horror, and Madness saves; they are outside the purview of luck and are not "active" effects that would be resisted. If a character succeeds at the Will save, then there is no effect, and she is immune to that specific source of fear, horror, or madness for 24 hours. If a character fails the Will save, then the margin of failure determines the result. Subtract the final check result from the DC; this result determines whether the character suffers a minor, moderate, or major effect.

  • Failure Margin........Effect
  • 1-5 points.............Minor
  • 6-10 points...........Moderate
  • 11-15 points..........Major
  • 16+......................Major, plus additional effect (see below for specifics).

When determining the results of failed Horror and Madness saves, the player also needs to roll 1d4 to select a specific effect.

Recovery Checks:
A character who fails a Horror or Madness save needs to make recovery checks to shake off its effects. Recovery checks are actually just Horror or Madness saves, usually with the same modifiers and DC. However, succeeding at a recovery check removes a Horror effect or lessens the severity of a Madness effect; failing a recovery check does not cause additional ill effects. Characters may take 10 on recovery checks. See "Recovering from Horror" and "Recovering from Madness," below, for more details.

Fear Saves:
A character should make a Fear save when facing overwhelming odds and/or immediate, dire physical danger. Fear saves can also be used to test the morale of the heroes' foes. Common fear triggers include the following.

  • The group is badly outnumbered or outclassed by opponents (EL is 4+ higher than the party level).
  • The most powerful character in the group or half of the group's members are killed.
  • A menacing creature is immune to the group's attacks.
  • A menacing creature is at least two size categories larger than the biggest member of the group.
  • A menacing creature has Frightful Presence special ability.
  • The character is helpless and threatened by immediate death (trapped underwater, for example).

Appearances are everything; if a character doesn't know he's in dire peril, then he has no reason to make a Fear save. Likewise, if a player thinks his hero is doomed, a Fear save may be warranted. Illusions can often trigger these "false" Fear saves.

Determining the Fear Save DC:
When a Fear save is prompted by a menacing creature, the DC is equal to 8 + 1/2 the creature's HD + the creature's Charisma modifier (if the threat has a Fearsome Presence, add 10 instead of 8). A GM in a rush can just set the DC to the menacing creature's CR + 8, which nets a roughly similar target number. When a Fear save is prompted by multiple creatures or a menacing situation, the DC is equal to the obstacle's EL + 8. This requires some judgment calls on the part of the GM; while a simple pit trap won't send anyone into a wild panic, a sealed room with sliding walls that slowly push the heroes into a pit filled with whirling blades might. Circumstance modifiers often factor into Fear saves. The modifiers below apply to the check and stack with each other.

  • Fear Save Modifiers:
  • Modifier........Condition
  • +4...........Character or ally possesses a weapon, or bit of knowledge that has proven to be useful against the threat.
  • +2...........Character or ally possesses a weapon, or bit of knowledge that is believed to be useful against the threat.
  • +4...........A loved one is endangered.
  • +2...........A friend or ally is endangered.
  • +1...........An Innocent is endangered.
  • +1...........Character has defeated a similar threat in the past.
  • +1...........Character is in close quarters (no place to run).
  • -2...........Character has faced and been defeated by a similar threat within the past 24 hours.
  • -2...........Character has faced and been defeated by a similar threat in the past (but not within the past day).
  • -1...........Character is alone.
  • -1...........Character has lost more than half of his or her maximum hit points.

Failure Results:
Minor Effect: Shaken. The character suffers a -2 morale penalty to attack rolls, checks, and saves.

Moderate Effect: Frightened. The character is shaken and flees as well as he can. He can fight to defend himself if unable to flee. A frightened character can use special abilities, to flee; indeed, he must use such means if they are the only way to escape.

Major Effect: Panicked. The character suffers a -2 morale penalty on saving throws and must flee. He has a 50% chance to drop what he's holding, chooses his path randomly (as long as he escapes from immediate danger), and flees any other dangers that confront him. If cornered, he cowers. A panicked character may use a special ability to escape. If the character fails the Fear save by 16+ points, he is panicked and must make an immediate Horror save (DC = failed Fear save DC - 5).

Additional Failures: Fear effects stack. A shaken character who fails another Fear save becomes frightened. A frightened character who fails another Fear save becomes panicked.

Recovering from Fear:
Fear effects last 5d6 rounds. Certain spell effects (such as modify memory or remove fear) can remove all Fear effects.

Horror Saves
When the heroes witness scenes of terrible cruelty or behold events that simply should not be, a Horror save is in order. Horror is a broader emotion than fear, and more intimate. Horror often permanently colors a character's view of the world, be it through the shock of realizing that such merciless events are possible or the paralyzing dismay of discovering some monstrous trait within oneself. Horror is the murderer of innocence. Possible examples of scenes that might require a Horror save include seeing someone torn limb from limb, watching a friend transform into a hideous monster, or learning that you slew an innocent bystander.

Determining the Horror Save DC
Horror saves are typically prompted by unusual, unique situations rather than by creatures, so unlike Fear saves there's no quick formula to determine the DC. Instead, the GM should use his best judgment to apply a DC to the scene. As a rule, the more gruesome, abnormal and/or insane the scene, the higher the DC should be. A few examples follow.

  • Horror...........Save Triggers
  • DC...........Horrific Scene
  • 5...........Signs of violence (a drying pool of blood, a splintered door, etc.).
  • 8...........A decaying body.
  • 10...........A scene of pain or suffering (a beggar ravaged by disease; a doctor sewing wounds shut).
  • 12...........A freshly slain corpse.
  • 15...........A scene of terrible agony (torture, involuntary transformation).
  • 20...........A scene of evil, cruelty, and madness (finding dismembered bodies that have been turned into marionettes).
  • 25...........Malign paradigm shift (see below).

A "malign paradigm shift" is a situation in which a character discovers that an important element of the surroundings is not only drastically "wrong," it has been so all along, unbeknownst to the character. Examples include PCs realizing that they are the only people in a crowded inn who aren't evil shapeshifters, or discovering that the carriers of a plague epidemic are actually all the victims of rampant vampiric feeding — and are still under the vampires' control.

Horror Save Modifiers

  • Modifier......Condition
  • +4...........A loved one is clearly endangered by the threat.
  • +4...........The victim of the threat is a despised foe.
  • +2...........A friend or ally is clearly endangered by the threat.
  • +2...........The victim of the threat is a foe.
  • +1...........An Innocent is clearly endangered by the threat.
  • -1...........An Innocent is participating in the scene (but not threatened).
  • -2...........A friend or ally is participating in the scene (but not threatened).
  • -4...........A loved one is participating in the scene (but not threatened).
  • -4...........Character is inadvertently responsible for the scene.
  • -1...........Character is in close quarters (no place to run).
  • +1...........Character is in an open area (room to run away).
  • +2...........Character has been warned about what she's about to witness.
  • +1...........Character has overcome or endured a similar event in the past.
  • -2...........Character has failed a Horror save prompted by a similar scene within the past 24 hours.
  • -1...........Character has failed a Horror save prompted by a similar scene in the past (but not within the past 24 hours).
  • -1...........Character is alone.
  • -1...........Character has lost more than half of his or her maximum hit points.

Circumstance modifiers often factor into Horror saves. All modifiers apply to the check and stack with each other. The GM will have to make judgment calls when applying some of these modifiers. For example, if a beggar suddenly grabs a hero's betrothed and starts to transform into a werewolf, the GM should apply a +4 bonus to the hero's roll (loved one threatened). On the other hand, if the hero's betrothed suddenly starts to transform into a werewolf, the GM may apply a -4 penalty (loved one involved) instead. Characters typically do not need to make Horror saves when witnessing the aftereffects of their own intentional actions. As an example, if PCs defeat a band of goblins in battle, they do not need to make Horror saves when examining the slain bodies. The same is true of monsters for their victims.

Failure Results:
If a character fails a Horror save, the player should roll 1d4 and compare it to the effect category to select a specific symptom of Horror. If a character fails a Horror save by 16+ points, he suffers a major Horror effect and must make an immediate Madness save (at DC = Horror save DC -5).

Player Tips: You can speed up Horror saves by rolling the d20 and the d4 at the same time — if you succeed at the Horror save, you can just ignore the d4 roll. Alternatively, if you and the DM both agree that a Horror effect in the category you rolled is particularly suited to the scene, you can ignore the d4 roll and simply choose that effect.
DM Tip: When a character fails a Horror save, make a note of the cause of the failed check, the failed save's DC, and the date in your campaign's calendar (a sample note might read: "Rotting body, Oct. 31, DC 8."). Horror saves have long-term results, and this information will come in handy later for recovery checks.

  • Minor.....Horror Effects
  • 1d4.................Effect
  • 1.....................Aversion
  • 2.....................Fearstruck
  • 3.....................Frozen
  • 4.....................Nausea
  • Moderate.....Horror Effects
  • 1d4.................Effect
  • 1....................Nightmares
  • 2....................Obsession
  • 3....................Rage
  • 4....................Revulsion
  • Major.....Horror Effects
  • 1d4.................Effect
  • 1....................Fascination
  • 2....................Haunted
  • 3....................Mental Shock
  • 4....................System Shock

Aversion: The character is frightened. Although the Fear effect has a duration of only 5d6 rounds, for as long as the character suffers from this Horror effect he is automatically shaken whenever he comes within 50 feet of the location where he failed this Horror save or any identical places.
Fearstruck: The character is panicked. This Fear effect lasts 5d6 rounds, but the character suffers no further effects.
Frozen: The character is momentarily overwhelmed by the scene before him and can take no action for three rounds. He is considered flatfooted for the duration.
Nausea: The sight causes the character to become physically ill. He suffers an effective decrease of 1d4+l points of Constitution. For an equal number of rounds, he cannot cast spells and can take only partial actions as he struggles to retain his last meal. The character regains these lost Constitution points at the rate of 1 per hour.
Nightmares: For the moment, the character is merely shaken. This Fear effect lasts 5d6 rounds. However, the next time the character tries to go to sleep, the horrific events of this scene will play themselves out again in his mind, causing the character to wake with a scream after only 5d6 minutes. The nightmares return every time he tries to sleep, preventing rest. For as long as this Horror effect lasts, the character cannot regain arcane spells, and each full day without rest incurs a cumulative -1 morale penalty to all attack rolls, saves, and checks, to a -4 maximum penalty.
Lack of sleep also erodes the character's health. Without rest, he cannot regain hit points through natural healing. Sleep can grant dreamless rest, allowing the character to regain spells and negate accumulated penalties. If the character does not receive a sleep spell every night, however, the nightmares begin again. Elves neither truly sleep nor dream and thus are immune to this effect; players of elven characters should reroll the d4 or choose another moderate effect instead.
Obsession: The character is unable to shake this horrific memory. He continually replays the events in his mind, mumbles about them under his breath, and tries to bring all conversations back to this terrible topic. His obsessed mind becomes clouded, and he seldom sleeps. With each day of restless obsession, he suffers a cumulative -1 morale penalty to initiative and Listen, Search, and Spot checks, to a maximum penalty of -4. The character ignores his health while obsessed. He cannot regain hit points through natural healing, and each full week without rest also inflicts 1 point of effective Constitution decrease. Once the character recovers from Obsession, lost Constitution points return at the rate of 1 per day. (See "Recovering from Failure," below.)
Rage: The character's mind is overwhelmed by a primitive, mindless fury directed toward the source of horror. He must drop anything in his hands that is not a weapon, then rush forward to attack the object of his hatred in melee. This blind fury acts as a barbarian's rage ability, with the following exceptions: unlike a barbarian, the character is not in control of his actions. He cannot retreat from battle and will not stop attacking the subject of his rage even if it is destroyed. He must also move toward the subject using the most direct route, even if this means passing through threatened areas. If anyone — even an ally — tries to block his path and he cannot move around, he must fight his way through the obstacle. The rage lasts a number of rounds equal to 3 + the character's (heightened) Constitution modifier. When the rage ends, the character regains control of his actions, but he is fatigued (as detailed under the Barbarian in the Player's Handbook).
Revulsion: Works as Aversion, except that the character is shaken if exposed to anything that merely reminds him of the horror scene. A character horrified by a vampire attack may suffer repulsion upon seeing a large swarm of bats or hearing the conversational mention of a vampire, for example.
Fascination: The character develops a morbid fascination with the scene. This obsession becomes so overpowering that it warps the character's personality. In the fascinated character's mind, the source of the horror effect becomes more and more powerful. The fascinated character may eventually believe that the source is omnipotent; he may even revere it. As an example, a character who becomes fascinated after witnessing a vampire draining the blood from a victim may seek out that vampire and offer his servitude. As the fascinated character warps himself into a willing slave of his own horror, he suffers a cumulative, effective drain of 1 point each from Wisdom and Charisma each week. If either score drops below 3, the character becomes a lost one (see "Additional Failures" under "Madness Saves"). Once the character recovers from Fascination, lost Wisdom and Charisma points return at the rate of 1 each per day.
Haunted: Witnessing the horrific scene shatters the character's ability to see any good in the world. He suffers the Obsession effect and also suffers 1d6+l points of effective Charisma decrease as his spirit becomes hardened and withdrawn. Once the character recovers from the Haunted effect, lost Constitution and Charisma points return at the rate of 1 each per day.
Mental Shock: The character's mind simply shuts down, unable to comprehend what it is witnessing. While suffering from mental shock, the character can take no actions and is considered flatfooted. He will walk if dragged along but cannot run. Mental shock lasts three rounds. At the end of that duration, the character must make another Horror save at the same DC to escape the effects. If he fails, the effects persist, but he can retry the saving throw once every three rounds until he succeeds. If the horrific scene is no longer present, the character gains a cumulative +1 morale bonus to each retry until he succeeds.
System Shock: The shock proves to be too much for the character's heart; he must make an immediate Fortitude save against the same DC or suffer 3d6 points of temporary Constitution damage.

Additional Failures:
Some Horror effects (such as Rage or Mental Shock) have outburst durations that can be measured in rounds, but all Horror effects actually linger for days. (See "Recovering from Horror" for long-term durations.) A character can carry only a single Horror effect at a time. If a subsequent failed Horror save indicates a result of equal or lesser severity, use another outburst of the existing effect. If a failed Horror save indicates a result of greater severity, remove the existing effect and default to the greater one instead. Horror effects do not stack.
Examples: Radford fails a Horror save, resulting in Rage (a moderate effect with a duration of two weeks). During these two weeks, any additional failed Horror saves indicating a minor or moderate effect automatically default to another bout of Rage. If Radford's player fails a Horror save indicating a major result, then determine it normally. In this case, a d4 roll comes up with Haunted. The Rage effect is then removed, and Haunted becomes the new default. Horror effect durations superimpose; the duration is measured from the time of the latest failed Horror save.

Recovering from Horror:
Minor Horror effects last one week. Moderate effects last two weeks. Major effects last thirty days. At the end of this duration, the character rolls a recovery check (a Horror save). Use the DC of the original Horror save with a -2 morale bonus, since time and distance heal all wounds. If the character succeeds at this check, the Horror effect is removed. If she fails, the Horror effect persists for another duration period. A character can retry failed Horror recovery checks each time she reaches the end of a duration period. The -2 DC modifier is cumulative with each attempt. Example: George makes a Horror save (DC 18), with his result a 14: a failure. Since George failed by four points (18 - 14 = 4), this results in a minor effect. After one week, he can make a recovery check at DC 16 (DC 18 - 2) to shake off the effects. If George fails this save, he can try again in another week at DC 14 (DC 18 - 4), and so on, until he succeeds. Numerous spells and magical effects (such as modify memory or remove fear) can also remove all Horror effects.

Determining the Madness Save DC
A Madness save's DC is determined on a case by-case basis. Mental Contact: If a Madness save is prompted by contact with an alien or insane mind, the DC is 10 + 1/2 the contacted creature's HD + contacted creature's Wisdom modifier.
Gaslighting: Gaslighting comes in two varieties. If an opponent tries to drive a character mad with a spell or other magical effect (such as bestow curse or wish), then default to the saving throw indicated by that spell (typically a Will save). That saving throw stands in for the Madness save. One character can also gaslight another through nonmagical means. To do this, the perpetrator must gain the victim's trust and remain in close proximity to the victim for thirty days, using that time to slowly convince the victim that her sanity is slipping away. At the end of the thirty days, the perpetrator must make an opposed Bluff check against the victim's Sense Motive check. If the victim fails this check, she has been driven mad; as with other Madness saves, the degree of failure determines the result (subtract the victim's Sense Motive result from the perpetrator's Bluff result).

The perpetrator can select a specific Madness effect from the selected category if he wishes. If the victim's Sense Motive check defeats the perpetrator's Bluff check, she is unaffected. If she succeeds by 10 or more points, she immediately becomes aware of the perpetrator's failed gaslighting attempt. If the perpetrator is not detected, he can try again (with each attempt taking another thirty days). Total Catastrophe: Madness saves prompted by personal catastrophes can be considered a particularly shattering form of Horror save. The DM should use the recommended DCs and modifiers listed under Horror saves, though this will often require the DM to make a judgment call.

Failure Results
Failed Madness saves can quickly hinder or cripple a character. As with Horror saves, the player should roll 1d4 and compare it to the failure category to select an effect. In addition to the listed Madness effects below, all failed Madness checks cause effective ability decreases to Intelligence, Wisdom, and Charisma. (Roll separately for each ability score.) A character with a minor Madness effect suffers a temporary decrease of 1d6 points per ability. The character regains 1 point in each ability score per hour. A character with a moderate Madness effect still suffers an effective decrease of 1d6 points per ability, but these points cannot be regained without effort. See "Recovering from Madness" below. A character with a major Madness effect suffers an effective decrease of 1d10 points per ability. As with moderate effects, these points cannot be regained without effort. If a character fails a Madness save by 16+ points, her mind is shattered. Unable to function, she immediately drops to -1 hit points and starts to die. If she survives this shock to the system, she suffers a major Madness effect and an effective ability decrease of 1d12 points per ability.

  • Minor Madness Effects
  • 1d4...Effect
  • 1.....Blackout
  • 2.....Denial
  • 3.....Horrified
  • 4.....Unhinged
  • Moderate Madness Effects
  • 1d4...Effect
  • 1.....Delusions
  • 2.....Depression
  • 3.....Hallucinations
  • 4.....Paranoia
  • Major Madness Effects
  • 1d4...Effect
  • 1.....Amnesia
  • 2.....Multiple Personalities
  • 3.....Schizophrenia
  • 4.....Suicidal Thoughts

All Madness effects described below are in addition to the effective ability decreases detailed above. As a note, minor Madness effects tend to be forgiving and pass within a few hours.
Moderate effects can be troubling, but PCs can usually continue to function. Characters suffering from major Madness effects often pose a danger to themselves and others and require close supervision.

Blackout: The character is merely shaken at first. However, she will not recall anything in the time period between (and including) the scene that prompted the Madness save and when she regains the last of her decreased ability scores. If the character is alone, the DM may simply cut to when she "comes to," wandering and alone, with no memory of how she came to be in her current location.
Denial: The character's mind refuses to accept the existence of the threat that prompted the Madness save. Until she regains all decreased ability scores, she acts as if this threat simply does not exist. Denial provides the character with an effective +4 insight bonus to any Will saves against that threat's attacks but otherwise offers no protection. When all ability scores are regained, the character once again acknowledges the existence of the threat (but loses the insight bonus). Horrified: The character suffers a moderate Horror effect (determined randomly). This Horror effect's duration lasts only until the character regains all decreased ability scores, rather than the usual two weeks.
Unhinged: The portion of the character's mind that should have gone mad simply shuts down instead. This leaves the character able to function but affects her personality. She receives an effective +2 morale bonus to all Fear and Horror saves, but her allegiance temporarily changes (roll 1d6 to randomly select a which type of allegiance gets changed by the GM [01 Person or Group, 02 Organization, 03 Nation, 04 Belief System, 05 Ethical Philososphy, 06 Moral Philosophy], omitting the character's original alignment from the options). A Sense Motive check (DC 20) can reveal that the Unhinged character is "not quite herself," assuming it isn't obvious. The character regains her normal allegiance (but loses the morale bonus) when all decreased ability scores are restored. An allegiance change due to this Madness effect does not cause an additional Madness check.
Delusions: The character believes something about herself that is simply not true. The nature of this delusion is usually tied into the event that provoked the Madness save. Examples might include a character who believes she has endless wealth (paying for services with pebbles she insists are rubies), believes she transforms into a wolf under the light of the full moon (and insists she must be caged), or believes that she is a specific NPC. The character can perform actions only if she can rationalize them within the context of her delusion. For example, a character who believes she is actually a vampire would not be willing to expose herself to sunlight. If a character ever performs an action that should be "impossible" within the context of her delusion (in other words, if the player cannot immediately provide a rationalization for the action), the character must make an immediate Horror check at DC 15.
Depression: The character is overcome by a deep melancholy, sapping away her will to live and her interest in the world around her. Such a character just wants to be left alone; she will not suggest ideas, give commands, or otherwise direct other characters. In fact, in any given situation, the character must make a Will save at the same DC as the failed Madness save to take any action whatsoever. If the character fails this Will save, she will do nothing at all, even in dangerous situations. In a combat situation, she cannot take any actions and is considered flatfooted. Even if the character is motivated to act, she does so listlessly and reluctantly. She can follow the instructions of allies, but she suffers an effective -4 morale penalty to all attack rolls, loses any Dexterity bonus to AC and Reflex saves, and cannot take attacks of opportunity. On the other hand, the character's utter lack of interest in her surroundings actually provides her with an effective +4 insight bonus to all subsequent Fear, Horror, and Madness saves.
Hallucinations: The character perceives something in the world that simply does not exist. In a sense, Hallucinations can be considered the "external" companion to the "internal" Delusions effect. As with Delusions, the nature of the hallucination is usually related to the event that prompted the failed Madness check.
Examples: A character might believe that she can see ghosts, that biting insects have infested her armor. She might even occasionally encounter an NPC who actually exists only in her mind.
In a sense, a hallucination can be thought of as a phantasm spell on the level of a major image, but one where the insane character is both caster and subject. As with illusions, the GM should present hallucinatory episodes as real events when they first manifest. Menacing hallucinations may provoke Fear or Horror saves (DC depends on the specific scene; see the respective sections on determining DC). Hallucinations can even attack the character, though they inflict only subdual damage, as the character merely believes she is being harmed. Characters have little mental defense against their own inner demons. Thus, a hallucinating character suffers a -2 morale penalty to all Fear and Horror saves provoked by her own visions.
If a character somehow becomes aware that her hallucinations are just that, she must still concentrate to convince herself that the visions are not real. This works just like disbelieving illusions; to dispel a hallucination, the character must make a Will save at DC (13 + character's Wisdom modifier). Unlike with illusions, however, the reassurances of allies cannot grant a hallucinating character any bonus to her Will save. An attempt to disbelieve a hallucination is a standard action and can be retried each round.
If a character successfully disbelieves a hallucination, the episode still continues for another 1d4 rounds. That hallucination can no longer provoke Fear or Horror saves, however, nor can it inflict subdual damage.
GM Tips: One way to present hallucinations is to secretly inform the other players of the nature of the character's madness. Later, once those players know that the episode the GM described won't be real, the GM can present the episode to the group as a real event, and only the hallucinating character will react as if the threat is real — adding to the insane character's confusion. The GM can then enhance this "rubber reality" scenario by letting the hallucinating character see a real threat that mimics a recurring vision. As an example, a character who hallucinates about monstrous wolves might be on watch, alone, when she spots a real pack of dire wolves skulking around the campsite. The other characters would then have to guess whether she was merely "crying wolf” again.
Paranoia: The character believes that she exists at the center of a conspiracy dedicated to her destruction. No amount of rational argument can convince her otherwise. Although the character's madness does not extend to actual hallucinations, the GM should present all NPCs and conversations with other characters in a menacing light. The GM might drop subtle visual clues that other characters are inhuman, or thread vague, easily misinterpreted "threats" into NPC dialogue. As with hallucinations, the GM may want to give the other players secret signals that the scene is not being presented quite as it actually exists, or the GM may want to focus on the paranoid character's interaction with NPCs only when separated from other PCs. This avoids the extra work of explaining what's really happening to the other players. The paranoid character must succeed at a Will save with a DC equal to that of the failed Madness save to place any trust in other characters. If the character fails the Will save, she must refuse all offers of help as being "obvious traps." If a paranoid character ever does come upon actual evidence that she has been betrayed or that others are conspiring against her, she must make an immediate Horror save (at DC 12 + character's Wisdom modifier). Amnesia: A much more disabling form of the Blackout effect, Amnesia is the result of an affected mind's desperate attempt to shield itself from the memory that provoked the failed Madness save. Throwing the baby out with the bathwater, the amnesiac character immediately blocks out all memory of the maddening event — along with many of the months or years that came before it. If a failed Madness save results in an Amnesia effect, the GM should roll d%. Multiply this percentage times the character's total levels (rounding down). The character then receives that many negative levels. Although an amnesiac character still has access to all of her skills, she loses all memory of events since gaining those levels. A character who acquires a number of negative levels equal to her character level regresses to childhood.
Multiple Personalities: The character's psyche makes a desperate attempt to contain the mental trauma it has suffered by splintering into separate identities. The character retains a core personality, 10d10 fragments, and 2d10 alter egos. The core personality is the character's original persona. It has access to all of the character's memories, skills, and abilities. Fragments are partial personas, easily described in a single phrase, such as "coin collector," "sleepy child," or "talented dancer." The player can assign a single skill or ability to each fragment. Fragments can use their one talent if called upon, but they always ignore anything that has no relation to their single subject. Alter egos are fully formed personalities. Each alter ego considers itself a distinct individual, but alters often believe that their race, class, or even gender differs from the core personality. As with Delusional characters, these alter egos cannot be convinced that they are not as real as the core personality. The player should flesh out the persona of each alter ego:

  • Roll 1d6 to determine each alter ego's approximate age. 1: Child. 2: Adolescent. 3: Adult. 4: Middle aged. 5: Old. 6: Venerable.
  • Roll 1d6 to determine each alter ego's supposed sex and race. 1: Same sex, same race. 2: Male, same race. 3: Female, same race. 4: Male, different race. 5: Female, different race. 6: Same sex, different race.
  • Roll d% on Table 5-5 in the Dungeon Master's Guide to select a trait as the base of the alter ego's personality.

Alter egos have access to all of the core personality's skills and abilities, but they will not use them if doing so is "out of character." The player should keep a numbered list of her hero's fragments and alters for ease of reference. Whenever a character suffering from Multiple Personalities has to make a Will save, she must also make an immediate additional Will save equal to the failed Madness save's DC or randomly switch personalities (as a free action). The character should also make a Will save (DC 15 + character's Wisdom modifier) each time she rests. If the character succeeds at the Will save, she wakes up as the core personality. If she fails, she switches to a random persona. The core personality has no conscious memory of time spent in other personalities, but the character does not acquire negative levels as with Amnesia. Alter egos typically are aware of each other and can "leave messages" for each other if they wish. It is not uncommon for alter egos to dislike each other or the core personality.
Schizophrenia: The character's personality suffers a serious collapse. As the character's sense of self erodes, she can experience drastic and unpredictable personality shifts. Once every week, and whenever the character makes a Will save of any kind, she must succeed at a Will save (DC 15 + character's Wisdom modifier) or have her allegiance immediately and randomly change. The player should roll 2d4 of different colors: one die represents ethical alignment (1: Lawful. 2: Neutral. 3: Chaotic. 4: Original allegiance); the other represents moral allegiance (1: Good. 2: Neutral. 3: Evil. 4: Original allegiance). A character might be a saint one moment, a monster the next. An allegiance change due to this Madness effect does not cause an additional Madness check.
Suicidal Thoughts: This is a more serious form of the Depression effect. In addition to all of the effects detailed under Depression, the character's will to live hangs by a thread. If the character fails any subsequent Fear, Horror, or Madness saves, she must soon (within an hour) make an attempt to take her own life. The character makes the suicide attempt via the most efficient means at her disposal: leaping off a high balcony, drinking poisonous chemicals, hurling herself into a river, and so on. A character can also use a piercing or slashing melee weapon to inflict a coup de grace against herself. This is also possible with some ranged weapons, such as crossbows and firearms.
Additional Failures
If a character fails another Madness save while already suffering a Madness effect, do not roll 1d4 to determine a new effect. The character's mind, already insane, merely sinks deeper into its existing dementia. Ability score decreases are cumulative with multiple failed Madness saves, however. If any of the character's mental ability scores ever drop below 3, she becomes what is commonly known as a lost one — a walking catatonic whose mind was shattered by memories too horrible to bear. The character becomes an NPC until she has at least a 3 in all mental ability scores; until then, the character eats and drinks if fed, walks if led, and may occasionally mumble some gibberish, but otherwise she can take no meaningful actions. The GM can shape a lost one's personality by looking at which ability score has dropped to 1 or 2. A lost one with minimal Intelligence may seem like a cheery and friendly fellow, but he might have absolutely no short-term memory. He is unable to remember anything about anyone from one minute to the next. A lost one with minimal Wisdom might have a vibrant memory but would be completely stymied by any kind of external task, such as opening a door latch or changing his clothes. A lost one with minimal Charisma might wander in a daze, mumbling strange rhymes, and is seemingly unable to register the existence of others. If any ability score drops to 0, the character slips into complete catatonia (see "Ability Score Loss" in the Dungeon Master's Guide). If all three ability scores are raised above 0 again, the character wakes up as a lost one.
Madness and Allegiance
Some Madness effects can cause a character's allegiance to temporarily change. This is an involuntary shift but does not require an additional Madness save. Some classes require specific allegiances. In these cases, the insane character should be considered an effective "ex" member of that class and may or may not lose class abilities. This loss of class abilities is only temporary; because the change is involuntary, the character is not considered to have actually abandoned the class. When the Madness effect causing the allegiance change is removed, the character's original allegiance is restored and she can continue to gain levels in that class as normal.
Madness and Campaign Style
To gain their full effect, Madness effects depend heavily on the players' willingness to portray various forms of mental damage. This isn't a problem in a campaign using a great deal of personality and character development. However many Madness effects run the risk of impairing the fun of the game. If Madness effects don't suit your style of play, it's best to simply remove them from the game. In this case, failed Madness saves only cause the effective ability decreases described above.
Recovering from Madness
The road from madness to sanity is often long and difficult. Madness effects are removed when all ability points lost to the failed Madness save are regained. In the case of minor Madness effects, this period is mercifully short: never longer than 6 hours. Moderate and major effects require much more effort to shake off. Several methods are available to characters in need of recovery:
Peace and Quiet: If the character rests for thirty days without failing any subsequent Will saves, she can make a recovery check (a Madness save) against the same DC. If this check succeeds, she regains 1 point in one of her decreased ability scores. While the player can choose which ability score to place the point in, the fastest road to recovery lies in restoring Wisdom to normal first. The character can attempt a new recovery check once per restful month against the original DC until Intelligence, Wisdom, and Charisma return to normal. However, particularly if the character's Wisdom score was drastically lowered by the Madness save, the DC may be so high that the character cannot succeed. In these cases, the character needs to turn to outside help.
Hypnosis: If the character does not have access to magic, access to a character with the Hypnosis skill is the next best option. Hypnosis is a new technique, first developed by or doctors. Hypnosis is primarily a nonmagical substitute for the hypnotism spell. When a character is curing madness, the DC of a Hypnosis skill check is equal to the DC of the subject's failed Madness save. The hypnotist may benefit from the modifiers listed on Table. If the hypnotist has at least 5 ranks in Heal, he gains a +2 synergy bonus to the skill check. The hypnotist can retry Hypnosis checks once per week (per subject) until the subject recovers. This means that the aid of a successful hypnotist can give the insane character four chances to make recovery checks each month, rather than just one. A character cannot use Hypnosis on himself. A successful Hypnosis check garners two results. First, the subject can attempt an immediate recovery check to regain a single ability point, as detailed under Peace and Quiet, above. Second, each successful use of Hypnosis reduces the DC of the recovery check by 1 point.
Hypnosis Therapy Modifiers

  • Modifier....Condition
  • +2.....The hypnotist can sense the subject's emotions through some means (including hypnotism and empathy).
  • +1.....The therapy takes places in a setting where the subject feels safe and comfortable.
  • +1.....The hypnotist has the same allegiance as the subject (disregarding Madness-induced allegiance change).
  • +1.....The hypnotist comes from a similar background as the subject (including homeland, social class, and character class).

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