Levels of Insanity (5e Variant Rule)

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Levels of Insanity[edit]

Being an adventurer can be hard, and sometimes certain creatures and events can have a great effect on your mental health such as:

  • Witnessing a friend’s violent death
  • Seeing a ghoul
  • Meeting someone you know to be dead
  • Finding a mangled human corpse
  • Undergoing severe torture
  • Seeing an evil deity
  • Surprised to find mangled animal carcass
  • Finding a stream flowing with blood
  • Seeing a corpse rise from its grave

When going through such encounters, your DM may ask you to make a Wisdom saving throw with a DC determined by your DM. On a failure, you increase a Level of Insanity. and a critical failure increases your Levels of Insanity by 2.

Levels Of Insanity
Level Effect

Disadvantage on Mental Ability checks and spells.


You will become frightened of random creatures, places and objects determined by your DM.


Disadvantage on Attack rolls, skill checks and Saving Throws.


Every hour, you must make a DC 12 Wisdom saving throw or be affected with Short-Term Madness for 1d10 minutes.


Upon reaching level five, you become mentally Paralyzed. If you are still at Level 5 of Insanity after 1d4 days, you progress to Level 6.


You go permanently insane and fall under the DM's control. A character with permanent insanity may be reduced to a raving lunatic or may be outwardly indistinguishable from a normal person: either way, they may never go back to who they once were.

Treating Insanity[edit]

There are multiple ways to decrease a characters levels of insanity. A Lesser Restoration spell will remove 1 level of Insanity while a Greater Restoration spell will remove 2. Other spells and effects (such as medicinal herbs, greater potion of healing) that boost Wisdom, Charisma and general health may also remove a level, but at your DM discretion.

A character may also take some personal time to refresh their mental state. Similar to a long rest, if interrupted by conditions that increase mental stress such as combat or damage, then the effects are not applied.This does not apply to 5th or 6th Levels of Insanity.

Mental Health
Level Amount of Time Nessesary

1-2 days




7-10 days


2-5 weeks

Permanent Insanity. Permanent Insanity is the most difficult to cure. It may be cured through powerful magical and other effects determined by your DM.

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