The adventuring life is not an easy one. Moving from town to town, delving into dark dungeons and hunting dangerous monsters for perhaps a few gold coins, is not a safe—or sane—way to make a living.

This chapter introduces mechanics to track a character's stress level and the lasting consequences these lingering, mental afflictions can have on their adventuring career.


Stress is a measure of pressure on a character's mental state, representing a build-up of negative emotions such as anger, fear, frustration, and irritation. Too much Stress is bad for your mental health and, if not treated carefully, can lead to detrimental Afflictions—or even death.

Characters can suffer up to 40 points of Stress before they reach breaking point. To prevent this, they'll need to find ways to relax and recover during downtime.

Gaining Stress

Stress is gained through danger, hardship, and adversity—suffering a critical hit from an enemy, hearing an unearthly moan from a dark room, sleeping rough in the cold rain, watching an ally die. Anything that threatens the mental well-being of your character can inflict Stress.

When choosing how much Stress to inflict, decide how significant the event is to the character—is it minor, moderate, major, or monstrous? The more emotionally significant, the higher the amount of Stress.

The more an event conflicts with the fundamental nature of your character, the greater the amount of Stress you'll suffer—a bard may be more embarrassed to ruin a performance than a wizard, while a lawful paladin is more hurt by a broken oath than a lawless rogue.

Gaining Stress

Category Stress Description
Minor +1 A small frustration, worry, or irritant: missing an attack, falling down, hearing a noise in the dark.
Moderate +2
You've made a critical error or something is seriously at risk: being caught lying, learning that the villain has escaped, being outnumbered.
Major +4
Something devastating to your character or their beliefs: breaking an oath, falling to 0 hp, finding a heap of fresh corpses.
Monstrous +8
(1d6 + 4)
Something incomprehensible or world-shattering: meeting a god, being betrayed by your closest friend, watching a loved one die.

Consequential Stress

You can gain Stress as a direct consequence of failing an action—missing an attack, breaking a lockpick, being caught in the middle of a lie. The GM will usually notify you that this is a risk before you make your attempt.

Here we see Chansi attempt—and fail—to pick a pick.

  • Chansi:Ok, let's see what's in this chest. I want to pick the lock on this thing—what's the DC?
  • GM:It's a secure metal chest, so DC 20.
  • Chansi:Easy. Lemme just... (rolls 15) ...ugh, fail.
  • GM:You hear the pins clicking in the lock, Chansi, but you can't understand why they're not setting. It's a frustrating failure for you—gain 1 point of Stress.

Stress Check

In cases where the environment or situation provokes an emotional response—standing before a dragon, entering a decrepit tomb, hearing a terrifying sound—you may be asked to pass a Stress check (Wisdom saving throw) to avoid gaining some Stress.

In this example, Viridian comes across a pile of rotting corpses and must pass a Stress check to keep his composure and avoid gaining Stress.

  • GM:You smell something foul, Viridian. Behind the wooden door, you can hear a faint buzzing sound.
  • Viridian:I open the door cautiously.
  • GM:Your torchlight illuminates a grisly scene—a dozen rotting corpses hidden in a small pantry, covered in a thick swarm of fat flies. The putrid stench of rotting flesh threatens to overwhelm you. Make a Stress check, DC 20.
  • Viridian:I'm... (rolls 22) ...phew, ok.
  • GM:Horrifying though this is, you manage to retain your composure. Perhaps this isn't the first time you've seen a heap of rotting corpses?

Here we see Valiant as he returns to town from an adventure, only to discover that he has been betrayed by a trusted mentor and his sister is in grave peril.

With his world turned upside down—and the town burning all around him—Valiant faces an almost impossible Stress check.

  • GM:Fire rages through the town. You hear a scream, Valiant, coming from the church. What do you do?
  • Valiant:Does it sound like Zelrya?
  • GM:It does, yes.
  • Valiant:I throw my shield aside and run through the burning streets, leaving the others behind.
  • GM:As you pass through the burning archway of Granite Pearl, you see Zelrya at the foot of the church steps. She is lying face down in a pool of blood. She isn't moving.

    Atop the steps stands Bishop Vendicus, a mad grin on his face and a bloodied dagger in his hands. "She's with the Grey King now, boy, He calls her to His hungry throne."

  • Valiant:Gods damn it Vendicus, we trusted you!
  • GM:Your sister lies dying, and your mentor has betrayed you, Valiant. Make a Stress check, DC 30.
  • Valiant:That... (rolls 22) ...bastard.
  • GM:Your mind reels from this horrific turnabout, Valiant—gain 8 points of Stress.


Too much Stress can be unhealthy for your character, causing long-term problems. When your character gains 20, 30, and 35 points of Stress for the first time after a long rest, they snap and develop a mental Affliction.

  • GM:In a very surprising turn of events, Krazak failed to smash open the chest with his headbutt. Krazak, you gain 1 point of Stress.
  • Krazak:These gods damned elven boxes. I'm up to 20 now—I've snapped. Time for a new Affliction...

Breaking Point

When a character gains 40 points of Stress, they hit breaking point. In this state, your character is reckless, dangerous, and extremely vulnerable.

If you are hit by a damaging attack while at breaking point, your character suffers a fatal heart attack. You fall to 0 hit points, fail any remaining death saving throws, and die immediately.

  • GM:The dragon lashes out at you, Clanda, swinging its huge tail. Make a defense roll, DC 32.
  • Clanda:I... (rolls a natural 1) ...ouch, take a critical hit.
  • GM:The dragon's tail slams into you without mercy. Take 26 points of damage, one notch on your armor, and 2 points of Stress.
  • Clanda:Damn, that puts me at 40 Stress.
  • GM:Your heart is pounding, Clanda, and it's hard to breathe. You're not sure you can take another hit...

Healing Stress

Stress is healed through success and relaxation—disarming a trap, defeating a formidable opponent, carousing in town, sleeping in a warm bed. Anything that helps your character feel better can heal Stress.

The amount healed depends on the significance to your character. The more it aligns with your character's personality, the more you heal (at the GM's discretion)—rogues benefits more than mages from lockpicking, while clerics benefit more than fighters from prayer.

Healing Stress

Category Stress Description
Minor −1 A small success or bit of good news: disarming a trap, playing a song, relaxing with your friends.
Moderate −2
A critical success or special achievement: eating a well-cooked meal, finding a hoard of treasure, repairing something important.
Major −4
You've beaten the odds and gained a major victory: defeating a dangerous enemy, saving an ally from death, completing a work of art.
Majestic −8
(1d6 + 4)
You've achieved a long-term goal or done something thought near impossible: bringing a friend back from death, finishing a masterpiece, receiving praise from your deity.

Here we see Clanda attempt to disarm a magical trap with her arcane training, healing Stress in the process. As a sorceress disarming a magical trap, she heals a moderate amount of Stress instead of a minor amount.

  • GM:The runes are glowing brighter, and you feel static building in the air. If you don't act quick, Clanda, this trap will explode.
  • Clanda:Pfft, this is amateur work—dwarven runes are so basic. I'll try to dispel the binding rune to disarm the trap harmlessly.
  • Valiant:Uh, are you sure about that? Last time—
  • Clanda:Hush now, I'm working.
  • GM:Ok, that'll be a DC 20 Wisdom check. You can use Arcana with this.
  • Clanda:See I told you, Valiant... (rolls 24) ...I got this.
  • GM:You manage to locate the binding rune and, with a careful words, draw the magic out of it. With a harmless spark, the runic trap shatters. Clanda, you heal 2 points of Stress—everyone else heals 1.
  • Clanda:Excellent. You're welcome, everyone.

It is much harder to heal Stress than it is to gain it, so you'll need to be proactive in treating your Stress level before it becomes insurmountable. Rest when you can, and try not to over-exert yourself.


While out travelling, a good time to heal Stress is during downtime and through sleep. Here, Sarien takes advantage of his downtime during a night's rest to meditate and clear his mind.

  • GM:Ok, camp's been set up for the night. What do you all do for the next few hours?
  • Sarien:I spend a couple of hours meditating.
  • GM:Ok—it's been an easy day, so make a DC 10 Wisdom check.
  • Sarien:No problem... (rolls 17).
  • GM:You're able to calm your mind and organize your thoughts, Sarien. Heal 2 points of Stress.

Taking a Long Rest

When you complete a long rest in a sanctuary, such as a village, town, or city, you heal all stress. Reduce your Stress level to 0.

Returning to the town of Darrowmore, Valiant takes a long rest and begins a week of training. Once the week is over, he reduces his Stress to 0.

Calm Emotions

When you are affected by the Calm Emotions spell—or other similar magic spells and effects—you heal a moderate amount of Stress.


An Affliction is a stress-induced mental issue suffered by a character when they gain too much Stress. Afflictions affect your character's abilities and can only be cured during downtime.

When you gain 20, 30, and 35 Stress for the first time after a long rest, roll on the Afflictions table to see which new mental Affliction you develop. If you roll a duplicate, roll again until you get a new result.


d100 Affliction Modifier
01-06 Fearful Disadvantage on WIS checks & saves
07-12 Lethargic +1 exhaustion until removed
13-18 Masochistic Disadvantage on CON checks & saves
19-24 Irrational Disadvantage on INT checks & saves
25-30 Paranoid Speed is halved
31-36 Selfish Disadvantage on CHA checks & saves
37-42 Panic Disadvantage on DEX checks & saves
43-48 Hopelessness Disadvantage on STR checks & saves
49-54 Mania Disadvantage on attack rolls
55-60 Anxiety Disadvantage on Stress checks
61-66 Hypochondria Hit point maximum is halved
67-72 Narcissistic Disadvantage on ability checks
73-77 Powerful +2 to all damage rolls
78-82 Focused +2 to all attack rolls
83-87 Stalwart +2 AC
88-91 Acute Advantage on INT checks & saves
92-96 Perceptive Advantage on WIS checks & saves
97-00 Courageous Advantage on CHA checks & saves
  • GM:Sarien, you hear a sickly moan from the shadows. Make a DC 10 Wisdom saving throw to see if you can keep your composure.
  • Sarien:Sure... (rolls 6) ...damn, not enough.
  • GM:Gain 1 point of Stress, Sarien.
  • Sarien:That pushes me over 20—looks like I'm feeling pretty... (rolls 41) ...panicked. How appropriate.

Curing Afflictions

Afflictions don't go away on their own—your character must dedicate time to treating their mental state. During a long rest, your character can attempt to treat one of their Afflictions in an appropriate fashion—carousing, praying, resting, meditating, etc.

Spend some gold to roll a d20 to make an Affliction Removal attempt. Some downtime activities, such as resting, may allow you to roll with advantage—bear this in mind if your Afflictions are proving hard to clear, before you become overwhelmed by them.

Affliction Removal

d20 Result
01 Critical Failure: You fail to cure your Affliction, gaining a new one in the process.
02-09 Failure: You fail to cure your Affliction.
10-19 Success: You cured your Affliction.
20 Critical Success: In a moment of clarity, you cleared yourself of all Afflictions and Stress.

You can only make one Affliction Removal attempt per in-game week, so make the best of it.


As you gain in experience, it becomes harder to reset your mental state—the things you have seen and experienced have had a lasting impact. It costs more to remove an Affliction the higher your level as you must seek more elite and exotic outlets.

Affliction Removal Costs

Level Gold
1 5
2 7
3 9
4 12
5 16
6 22
7 30
8 42
9 58
10 81
11 113
12 158
13 221
14 309
15 432
16 604
17 845
18 1,183
19 1,656
20 2,318

Greater Restoration

The Greater Restoration spell may be used to let you make an Affliction Removal attempt outside of a long rest. This counts as your once-per-week removal attempt.

From levels 1-10, you may roll your Affliction Removal check with advantage when using Greater Restoration. From levels 11-20 however, roll with disadvantage.

Mental Breakdown

If your character gains more than 3 Afflictions, they suffer a complete mental breakdown—your character falls catatonic and must be committed into care or die.

A character who has had a breakdown can no longer be played—treat them as if they have retired.


If a character is placed in good care, there is a rare chance they may eventually recover from their breakdown. For each month of proper care, they may roll an Affliction Removal attempt with disadvantage. A month after they have removed all Afflictions, they recover their senses and can be active again.

Each time a character recovers from a breakdown, their minimum Stress increases by 10.

Items & Consumables

Across your adventures, you may be able to buy, craft, or loot special items that can help you to manage stress—magic gear, soothing teas, precious potions, etc.

Soothing Stones

  • Item (Small)
  • Common

A pair of small, stone balls engraved with dwarven runes. They make a soothing sound when held in one hand.

  • Relaxing Sound During camp, if you successfully Relax in Solitude, you heal an additional +1 Stress.

Elixir of Sanity

  • Potion
  • Consumable

This thick purple elixir looks almost alive. When you stare at it, you get the feeling you're being watched.

  • Iron Soul When you drink this elixir, you may roll any Stress checks with advantage for one hour.

Ring of Clarity

  • Item (Small)
  • Rare

This fine silver ring, forged by the drow monks of Elgin Orsul, is set with a tiny astral topaz.

  • Clear Mind When you wear this ring, you can increase your maximum stress by +8.

Book of Sermons

  • Item (Small)
  • Common

A cheap but illustrated book of inspiring sermons from a particular religion.

  • Sermon During camp, you can attempt to read a sermon from the book. If you successfully Tell a Story, you heal an additional +1 Stress.
  • Preach When you read from this book, you have advantage on Charisma (Religion) ability checks while preaching about this book's subject religion.

Greenleaf Tea

  • Item (Small)
  • Common

A packet of halfling tea leaves. One packet contains enough leaves for five separate brews.

  • Delicious Tea If you successfully Brew Drinks using one charge of tea leaves, each person who takes a drink can heal an additional +1 Stress.

Variant Dials

Stress & Afflictions is a flexible game mechanic that can be adjusted to suit a variety of settings and gameplay styles. If you want to customize the experience for your game, consider using some of these variant dials.

AOne Snap

If you want to make afflictions a little rarer in your game—or prevent rapid escalation once a character reaches 50% stress—consider this One Snap variant.

The first time you gain 50% or more Stress after a long rest, you snap and develop a mental Affliction. You can only snap once per long rest, though you still risk hitting your breaking point if you reach 100% Stress.

BInsanity Zones

You may want to use Stress & Afflictions for just a short time in your campaign—to add theming to a particular region or adventuring site, for example. You can achieve this with insanity zones.

Creating an Insanity Zone

Stress is only gained in certain areas—insanity zones. Outside of these zones, characters don't gain stress—though they still suffer the effect of any lasting afflictions.

An insanity zone can be anything—a room, a dungeon, a kingdom, etc—so add them to your game as best suits your setting. Use them to add memorable features to your dungeons and adventure hubs.

Chansi and Viridian approach the Tomb of Eldritch Horror, an ancient dungeon corrupted by aberrant powers. The tomb is an insanity zone—within its walls, players risk gaining stress.

Leaving an Insanity Zone

If you leave an insanity zone, your stress and afflictions remain until you complete a long rest (or perform another form of recovery action, such as spending hit dice or acquiring consumables).

CTemporary Virtues

Some afflictions—such as Powerful and Focused—can be a benefit to your character. With this Temporary Virtues variant, these effects become short-lived.

If you develop a beneficial affliction, it is automatically cured without cost at the end of your next long rest.

DRestful Recovery

If you are running an episodic game and need to drastically limit the running scope of stress and afflictions, consider using this Restful Recovery variant.

When you complete a long rest in a sanctuary, you automatically recover all stress and cure all afflictions.

EStressful Attacks

If you want to disconnect Stress from abstract failure, consider instead attaching stress to monsters and traps with Stressful Attacks.

Give your monsters and traps attacks that deal stress damage instead of—or in addition to—hit point damage. These stressful attacks can be a very effective way to add flavor to your aberrant and psychic monsters—especially those that use fear and intimidation powers.

Gibbering Horror

Level 5 Supporter
  • Medium aberration, neutral
Standard (450 XP)
  • Armor Class14
  • Attack Bonus+5
  • Hit Points45 (23)
  • Damage8
  • Speed30 ft
  • Spell DCs13, 10
Str +3
Dex +1
Con +4
Int +0
Wis +2
Cha +1
Saving Throws Con +6, Str/Wis +3, Dex/Cha/Int +0
Skills Initiative +5, Perception +2, Stealth +2
Immunities Prone
Senses Darkvision 60 ft., passive Perception 10

Bite (common)

Melee 5 ft: +5 vs AC. Hit: 8 piercing damage.

Mad Gibbering (common)

Melee 5 ft: DC 13 vs Wisdom. Hit: The target gains +2 (1d4) points of Stress.

Screaming Skull

  • Trap
  • Area Attack

A grinning skull of an monstrous creature hangs on the wall. When a visible creature steps within 5 ft of the skull, it unleashes a piercing scream that chills the heart of everyone within 15 ft. The skull then crumbles into dust.

  • Attack DC 15 vs Intelligence.
  • Hit The target gains +2 (1d4) points of Stress.

Giffyglyph's Monster Maker

For more advice on creating monsters and attacks, try Giffyglyph's Monster Maker—a supplement with guides and templates to help build new monsters in seconds.

FLeveling Stress

As you gain power and knowledge, your ability to handle stress also improves. With Leveling Stress, your stress limits and snapping points are influenced by your character level and intelligence modifier.

Calculate your maximum stress and snapping points as follows, rounding down when necessary:

Leveling Stress

Maximum Stress: 20 + level + (4 x INT)

Snapping Points: 50% / 75% / 87.5%

Minimum Stress

Your baseline maximum stress as calculated here can't go below 16, regardless of your intelligence modifier.

Gaining Stress

When using this variant, be mindful of how much Stress you deal to low-level characters. A 1st-level character with −1 INT has only 17 maximum stress and snaps at 8/12/14 points of stress—a very short fuse indeed.

Try to limit yourself to minor and moderate stress checks where appropriate at lower levels, and reserve major/monstrous for the most extreme of situations at higher tiers of gameplay.

GLight & Shadow

If you are using the Light & Shadow () rules and want visibility to be an even bigger threat to your players, consider this variant.

If you are blinded, you are vulnerable to stress—you gain twice the amount of stress as you normal would.

HIndefinite Madness

If you don't want characters in your game to die outright when they are at breaking point, consider afflicting them with Indefinite Madness instead.

If you are hit by a damaging attack while at breaking point (100% Stress), you fall unconscious. No amount of jostling or damage can wake you.

After 2d4 hours, you awaken with an indefinite madness—roll on the Indefinite Madness table (DMG p260) to see what you are afflicted with.

ISlow Recovery

If you want to make it harder for characters to recover from Stress, then consider this Slow Recovery variant.

Anytime you would heal Stress, reduce the amount healed by half (don't round this halved amount).

Valiant heals a minor (1) amount of Stress from his daily prayer. Because of Slow Recovery, however, he instead heals only 0.5 Stress.

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