Loss of Sanity

Character Sanity Scores

Sanity, Insanity and Disorders

Forbidden Tomes and Knowledge

Types of Insanity

Indefinite Insanity and Disorders

Gaining or Recovering Sanity

House Rules

Characters ordinarily lose Sanity in a few types of circumstances: when encountering something unimaginable, when suffering a severe shock, after casting a spell or when learning a new spell, when being affected by a certain type of magic or a particular spell, or when reading a forbidden tome.

Sanity Resistance

Since your characters live in a world of magic and monsters, they are less susceptible to Sanity loss caused by encountering strange creatures (see Table: Sanity Loss from Creatures). You are allowed a measure of Sanity resistance equal to his Wisdom modifier. This number is the amount of Sanity loss a character can ignore when he encounters a creature that requires a Sanity check.

Sanity resistance also applies to certain kinds of severe shocks (although it might not apply to personally horrific experiences, such as seeing a close friend die) and to the casting or learning of certain spells or rituals.

Encountering the Unimaginable

When people perceive creatures and entities of unspeakable horror, this experience costs them some portion of their minds, since such creatures are intrinsically discomforting and repellent. We never lose awareness of their slimy, fetid, alien nature. This instinctive reaction is part and parcel of humans, elves, dwarves, and other humanoid races. In this category, we can include supernatural events or agents not always recognized as specifically devoted to these dark gods, such as hauntings, zombies, vampires, curses, and so on.

Table: Sanity Loss from Creatures provides some default Sanity loss values for encountering creatures, based on their type and size. These are only default values—the GM can and should adjust individual monsters he deems more or less horrible than others of their size. An aasimar, for instance, hardly presents a Sanity-shaking sight, and should probably be treated as a humanoid rather than an outsider. On the other hand, a vargouille—a Small outsider appearing much like a flying, bat-winged head—might provoke a much more visceral reaction than other Small outsiders.

In addition, certain types of monstrous behavior might force additional Sanity checks, much like those described under Severe Shocks, below. For instance, an aboleth is an unnerving sight, but watching one transform your best friend with it’s slime should certainly force another check, with losses appropriate to the situation.

No character needs to make a Sanity check when encountering an elf, dwarf, or other standard humanoid race, or for encountering domesticated or otherwise commonplace animals. In some cases, even humanoid races such as orcs and goblins might be so common as to not cause Sanity loss either.

Specific Monsters and Sanity

Some monsters have additional or variant special abilities when using the Sanity variant.


The allip’s madness ability causes the loss of 2d6 Sanity points rather than the normal effect.


The derro’s madness ability protects these creatures from any further Sanity loss. Sane derro (especially derro player characters) track Sanity points normally.

Monstrous Characters and Sanity

In most cases, the GM does not need to keep track of a monster’s Sanity score, but sometimes, especially when in the hands of a player, monsters need Sanity scores just as other characters do.

Table: Sanity Loss from Creatures

Monster Size
Monster Type Up to Tiny Small Medium Large Huge Gargantuan Colossal
Aberration, dragon, ooze, outsider, undead 1/1d4 1/1d4 1/1d6 1/1d10 1d4/1d10 1d6/1d10 1d6/2d10
Elemental, fey, plant, vermin 0/1d4 1/1d4 1/1d6 1/1d8 1/1d10 1d4/1d10 1d4/2d6
Construct, giant, magical beast, monstrous humanoid 0/1 0/1d4 0/1d6 1/1d6 2/2d6 2/2d6 3/3d6
Animal, humanoid 0/01 0/11 0/11 0/1d41 0/1d4 0/1d4 0/1d6
1Only animals or humanoids of truly bizarre or ferocious appearance force such a check.

Severe Shocks

A shocking sight of a more mundane nature can also cost Sanity points. Severe shocks include witnessing an untimely or violent death, experiencing personal mutilation, losing social position, being the victim of treachery, or whatever else the Game Master decides is sufficiently extreme. The following list gives some examples of severe shocks, and the Sanity loss each one provokes.

Sanity Lost1 Shocking Situation
0/1d2 Surprised to find mangled animal carcass
0/1d3 Surprised to find human corpse
0/1d3 Surprised to find human body part
0/1d4 Finding a stream flowing with blood
1/1d4+1 Finding a mangled human corpse
0/1d6 Awakening trapped in a coffin
0/1 Suffering a Critical Hit
1/1d4 Suffering a Serious Wound
1/1d6 Losing a Limb
0/1d6 Witnessing a friend’s violent death
1/1d6 Seeing a ghoul
1/1d6+1 Meeting someone you know to be dead
0/1d10 Undergoing severe torture
1/d10 Seeing a corpse rise from its grave
2/2d10+1 Seeing a gigantic severed head fall from the sky
1d10/d% Seeing an evil deity

1Loss on a successful check/loss on a failed check.

Sanity-Affecting Magic

The following types of magic and specific spells have different or additional effects when the Sanity variant is in use. For the effects of healing spells and magical means of recovering sanity, see Restoring Sanity with Magic, later in this section.

Fear Effects

Whenever a spell, creature, or other factor produces a fear effect that causes its target to become shaken, frightened, or panicked, replace the saving throw to avoid the effect (if applicable) with a Sanity check. On a failed check (and sometimes even on a successful one), the subject loses a number of Sanity points rather than experiencing the normal effect of the magic. The table below provides a summary of the Sanity loss associated with each spell that has the fear descriptor:

In this variant, remove fear does not automatically suppress an existing fear effect on its subjects, but if it is cast on a creature that lost Sanity because of a fear effect within the last 24 hours, that Sanity loss is halved (to a minimum of 1 point) and the creature’s current Sanity is adjusted accordingly.

Table: Sanity Loss from Fear Effects

Sanity Loss on Sanity Loss on
Spell Failed Check Successful Check
Cause fear 1d6 1
Doom 1d6
Fear 2d6 1
Phantasmal killer2
Scare 1d6 1
Symbol of fear 2d6

1Bane works normally because its effect is less severe than that of the shaken condition.
2Phantasmal killer and weird work normally because those spells do not produce a shaken, frightened, or panicked effect. (The GM could rule that a Sanity check takes the place of the Fortitude save to avoid dying from fear; in such a case, failing the check results in permanent insanity.)


Illusions, when they are believed, cause Sanity loss just as if the real horrific monster or event were present.

Bestow Curse

Depending on the nature of the curse, this spell can cause a Sanity check rather than a Will save. If such is the case, and the victim fails the Sanity check, he loses 3d6 points of Sanity. Unlike normal Sanity loss, this number is also subtracted from the character’s maximum Sanity. Magic that removes the curse (such as remove curse or break enchantment) can restore the character’s normal maximum Sanity, but separate magic or the use of the Heal skill is required to restore the character’s current Sanity.

Contact Other Plane

Characters casting this spell risk a loss of Sanity instead of Intelligence and Charisma. Whenever a character casts this spell, she must make a Sanity check. If the check fails, the character loses Sanity depending on the plane that the character was trying to contact, according to the table below. Unlike the Intelligence and Charisma reduction caused by the normal version of this spell, the Sanity loss does not go away after a week—the loss is permanent until restored by another spell or through the use of the Heal skill.

Table: Contact Other Plane

Plane Sanity Loss
Elemental Plane (appropriate) 1
Positive/Negative Energy Plane 1
Astral Plane 2
Outer Plane (demideity) 1d6
Outer Plane (lesser deity) 2d6
Outer Plane (intermediate deity) 3d6
Outer Plane (greater deity) 4d6


Replace this spell’s XP cost with a Sanity check (1d6/3d6), made as a free action immediately after the spell’s duration expires. Insanity: Instead of experiencing this spell’s normal effect, characters who fail the saving throw to resist the spell become permanently insane as described in this variant (but suffer no Sanity loss).

Moment of Prescience

In addition to the spell’s normal benefits, a character with an active moment of prescience effect can make one Sanity check as if his current Sanity equaled his maximum Sanity. The character need not use the effect on the first Sanity check he is required to make, but he must choose whether or not to use this benefit before making any Sanity check during the spell’s duration.


In addition to the spell’s normal effect, the caster can sense whenever the subject suffers Sanity loss, temporary insanity, indefinite insanity, or permanent insanity during the spell’s duration.

Summon Monster

If a character summons a monster that causes Sanity loss by means of a summon monster, summon nature’s ally, planar binding, or planar ally spell, he must make a Sanity check because of the monster’s presence only the first time that particular individual creature is summoned. See Summoning Individual Monsters and Summoning Individual Monsters.

Symbol of Insanity

Instead of experiencing this spell’s normal effect, characters who fail the saving throw to resist the symbol become permanently insane as described in this variant (but suffer no Sanity loss).

Loss of Sanity

Crimson Skies PhoenixMark