Insanity is an affliction inflicted upon those who suffer from extraordinary physical, mental, or spiritual anguishes and trials. Insanity can also be caused by exposure to particularly potent sources of unhinging horror, madness, or alien natures, such that the mind simply cannot withstand them. Insanity is a mind-affecting effect.
In-game, a person has a chance of going insane every time he suffers a tremendous shock to one of his mental ability scores—Intelligence, Wisdom, or Charisma. Every time a creature is reduced to a score of 0 in one of these scores, here’s a chance he goes insane. (Note: Wisdom damage is particularly likely to cause insanity, since a 0 Wisdom score imparts a –5 penalty on all Will saves.) Either roll on the table on this page or select an insanity appropriate to the cause of what reduced the victim’s score to 0. You should make the victim’s saving throw in secret—he should not know the result, nor the type of insanity that might afflict him. These effects should play out naturally— some insanities (like phobias) take days or even months to trigger or have effects, while others (such as paranoia) are immediately obvious.
At your option, a creature can run the risk of going insane under extremely unusual situations, even when his mental ability scores are unharmed. A character suffering from long imprisonment might have to make a save against developing agoraphobia or claustrophobia. Someone repeatedly betrayed by allies might have to make a save against developing paranoia. And a poor soul whose mind is possessed by a powerful demon might have to make a save upon being exorcized to keep from becoming psychotic. The causes of such insanities are left to you as the GM to determine.
Insanity can also be inflicted via magic. Consider allowing the spell insanity to merely inflict 1 randomly determined insanity per 5 caster levels on its victim rather than causing permanent confusion. Bestow curse can also inflict a single insanity on a foe, although in this case the insanity is also a curse.
It’s possible to suffer from multiple forms of insanity. If you become afflicted with a form of insanity you are already suffering from, the current DC of that insanity increases by +5.
All insanities have a DC that represents the insanity’s strength. An insanity’s DC indicates the Will save you need to roll in order to resist contracting the insanity when you are initially exposed to it, but also the DC you need to make to recover. Recovering from an insanity naturally is a lengthy process—once per week, you make a Will save against the insanity’s current DC. If you succeed on this save, the insanity’s DC is reduced by a number of points equal to your Charisma bonus (minimum of 1). You continue to suffer the full effects of the insanity until its DC is reduced to 0, at which point you are cured and the insanity vanishes completely.
Lesser restoration has no effect on insanity, but restoration reduces the current DC of one insanity currently affecting a target by an amount equal to the caster’s level. Greater restoration, heal, limited wish, miracle, or wish immediately cures a target of all insanity.
When a creature goes insane, roll on the following table to determine what form of insanity strikes. Alternatively, you can assign the insanity to match the cause.
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