D&D 5E (2024) Representing afflictions in D&D 5e - which do you think work best/least dislike.

[Li Shenron]

My favourite would be ability score damage, because it's simple to track in 5e (compared to other editions) and still gives enough variety. Temporary or permanent? While the word "permanent" is very scary for PCs, in practice it would always mean "permanent until cured". Temporary gives more mind relief to the players, but a possible side effect could be to turn it into an annoyance that players just soak it up and just wait until it disappears. I would rather have the occurrence of an affliction be more scary than annoying, and prompt some action from the players. So technically I would go with "temporary" and the caveat that this allows me to set all sorts of durations (and even more complex twists such as progression downward or upward) including a duration so long that it is actually permanent, but the real key for me would be to not disclose to the players what the duration is or even whether it's temporary, permanent but stable, or a death spiral: if they don't know for sure, it will be scary and they will act.

As a side note, I totally expected exhaustion to win the poll. It doesn't really work well IMHO, but it's the most frequently talked-about mechanic, and polls drag answers based on trends rather than real opinions.

 

[I'm A Banana]

Back in 3e and Pathfinder 1 the many varied afflictions: poisons, diseases, curses, life draining, aging etc were generally handled though ability score damage either temporary or permanent. Purple worm poison will reduce your Constitution score, filth fever reduces your Dex and so on.

5e has largely moved away from this towards other methods of representing ongoing penalty. A reduction in Max hp, the poisoned condition or exhaustion for instance.

As a DM which work for you? Which do you like to inflict on your players?

As a player which do you least-dislike? Which are your preferred methods of representing ongoing injury/curse/poison/disease etc.

Explain your reasons below. Also if I’ve missed any key ones out let me know and I’ll add them in.

Some of these are very DIFFERENT effects! I would not use the same system for Disease that I'd use for Energy Drain, for instance.

I like 4e's system for diseases, but it is a lot to track and it's not a small lift to "design" a disease in it.

I do think that the rolls against disease should happen during a long rest. The diseases in the DMG all have this incubation period that I think kind of messes with the pacing.

One of the options not in the poll is "Cannot benefit from rests," which is one of my favorite ways to do diseases since it makes the illness important for the PC's to deal with.

It's also a great way to introduce the stakes to the PC's:

Party: "OK, to prepare to fight the wererat at full power, we're going to take a long rest."
DM: "OK. Lidda, roll a CON save."
Lidda's Player: "What?! During a REST?! What the hell? Ummm....oh dang, that's an 8."
DM: "You finish your Long Rest, but Lidda, you don't actually benefit from it. You tossed and turned and you woke up feeling awful. Nauseous. Feverish. You've caught an illness. You're now diseased and you can't benefit from rests until you're cured."
Lidda's Player: "Hey, um, I'm still down half my hit points, guys. Maaaaybe we deal with this before we fight the wererat?"

One thing to note is also that I don't think magic should be able to just heal your disease. For this reason, I like treating Diseased as a separate condition from Poisoned or Exhaustion. A disease might give you all three! And the cleric can cast Lesser Restoration to remove the Poisoned condition, and you can press on, but you're still Diseased, and so you're still not benefitting from rests. This applies to your injuries, too -- you can't heal them by resting, but the cleric can still cast cure wounds on you and give you some staying power. This kind of reflects taking asprin or something: you feel a little better with effort, but you're still sick. Magic can't remove the Diseased condition.

 

[Corinnguard]

In Level Up, there are two Trackable Conditions that the characters can find themselves dealing with, Fatigue and Strife. Fatigue represents exhaustion, exposure, hunger, injuries, and other physical factors which gradually wear a creature down. Strife otoh represents corruption, despair, fear, loss of resolve, and other mental factors which gradually undo a creature’s very soul. A character can experience up to 7 levels of Fatigue or 7 levels of Strife. A long rest in a safe place can undo one level of either one. If a character reaches the 7th level of Fatigue, they get the Doomed condition and die. Getting 7 levels of Strife results in a special, permanent effect chosen or randomly picked by the Narrator.

 

[TheSword]

There was something I missed out actually.

Is there mileage in malignancy effects being represented by a flaw. Similar to how madness is represented in 2024? A roleplaying trait which the player is invited to fold into their character without a mechanical effect? For instance if the disease causes the flux the player is invited to roleplay needing sudden and essential trips to the privy.

 

[Lanefan]

"Other" - all of the above, with one exception: straight hit point damage is boring.

Affliction effects should be highly variable, depending on their source and specifics. I also maintain they should be curable, at cost of some resources and with success not guaranteed.

Missing from the list of options:

Slowed (i.e. movement greatly hampered, walk at half speed max, cannot run)
Incapacitation (i.e. forced bed rest, cannot travel unless carried, needs constant care)
Progressive (i.e. gets worse, ending in death after x-amount of time, unless cured)
Combination of Effects (i.e. more than one thing from this list, cumulative)

 

[the Jester]

It just depends on the nature of the affliction. I like to use varied mechanics for these kinds of things, so that each instance stands out as different. In other words, I want two diseases afflicting the party to work differently.

 

[TheSword]

It just depends on the nature of the affliction. I like to use varied mechanics for these kinds of things, so that each instance stands out as different. In other words, I want two diseases afflicting the party to work differently.

Sure, what kind of effects do you prefer though?

 

[TheSword]

One thing to note is also that I don't think magic should be able to just heal your disease. For this reason, I like treating Diseased as a separate condition from Poisoned or Exhaustion. A disease might give you all three! And the cleric can cast Lesser Restoration to remove the Poisoned condition, and you can press on, but you're still Diseased, and so you're still not benefitting from rests. This applies to your injuries, too -- you can't heal them by resting, but the cleric can still cast cure wounds on you and give you some staying power. This kind of reflects taking asprin or something: you feel a little better with effort, but you're still sick. Magic can't remove the Diseased condition.

I am thinking about separating the symptoms of the disease and the illness itself. The lesser restoration would cure the original disease but not necessarily instantly remove all the symptoms.

 

[the Jester]

Sure, what kind of effects do you prefer though?

It depends on the affliction in question. For example, for a bad luck curse, I have used a "dm's discretion, stuff breaks in your backpack, it rains on you, etc" with a minimal framework of mechanics, whereas for the hot shakes (a disease) I gave disadvantage on Dex attacks and checks and gradually increasing exhaustion until cured or the victim died. Meanwhile for filth fever I might give the poisoned condition until cured, and for a long-term, slow acting poison, I might inflict a certain amount of damage per hour or day.

I tailor the nature of the effects to the affliction.

 

[Greg K]

Skirmisher Press needs to do a 5e version of their Insults & Injuries which was a supplement on real-world diseases by a gamer/practicing medical doctor. I have both the 3.5 and Pathfinder versions and would buy a 5e version as well.