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Effects of Sanity Damage

Source Horror Adventures pg. 12
When you experience a potential sanity attack, you must typically succeed at a Will saving throw to shake off or reduce the sanity attack’s damage. Whether this saving throw is successful or not, if the sanity damage from a single sanity attack is equal to or greater than your sanity threshold, you gain a madness with a potency based on the relation between your total sanity damage accrued and your sanity edge (lesser if the total sanity damage is below your sanity edge, greater otherwise). In most cases, GMs should choose a madness that reflects the horror faced or your deep fears and potential mental breaking points rather than rolling on tables. For instance, if you gain a lesser madness due to an encounter with a mummy or some other undead that features a fear effect, it might make sense to choose the phobia madness. If you already suffer from delirium and gain a greater madness, it might make sense for that madness to be increased to schizophrenia. However, when a random madness is appropriate, the GM can generate one by rolling on Table 5–1 (for a lesser madness) or Table 5–2 (for a greater madness).

You are afflicted with a madness until that madness is removed by the methods described in Chapter 5. You may not always manifest the madness, though. If you are afflicted with madness and then are healed of all sanity damage, all of your madnesses become dormant until you accrue further sanity damage. Typically, a dormant madness does not affect you at all, but some madnesses feature an effect that occurs only while that madness is dormant. A lesser madness that becomes dormant does not manifest again until you take sanity damage equal to or greater than your sanity edge. A greater madness stays dormant only as long as your total sanity damage remains at 0. Dormant madnesses, no matter the potency, can be removed only by miracle or wish.

Lastly, if your total sanity damage equals or exceeds your sanity score, you become insane as per insanity (no saving throw) until all your sanity damage is healed and all your madnesses are cured.

While Pathfinder RPG Horror Adventures introduces a number of spells, feats, monsters, or other effects that deal sanity damage, the GM is also encouraged to create her own sanity-damage-dealing effects in her horror game. The table below gives a number of examples of situations that might cause a character to take sanity damage.

The first time a character encounters a dead body101d3 sanity damage0 sanity damage
The first time a character encounters a gruesome scene of death121d6 sanity damge1 sanity damage
The first time a character encounters a horrifying creature*10 + CR of the creatureSanity damage equal to 1/2 the creature's CRSanity damage equal to 1/4 the creature's CR
Each time a character encounters a qlippoth or other creature with a particularly horrific appearance10 + CR of the creatureSanity damage equal to the creature's CRSanity damage equal to 1/2 the creature's CR
Each time a character encounters a Great Old One15 + CR of the creatureSanity Damage equal to double the creature's CRSanity damage qual to the creature's CR
* Horrifying creatures are typically aberrations, evil or chaotic outsiders, and undead. “Each time” could mean the first time for each creature type, or each time a creature encounters a new kind of specific creature of that type (for example, the first time a creature encounters a skeleton and then again the first time the character encounters a wraith), at the GM’s discretion.

Expanded Sanity

Effects dealing sanity damage and madnesses are mind-affecting effects, and as such certain creature types are immune to them. In horror games, the GM may want to make an exception to this, at least in the case of sanity damage and madnesses, allowing undead and even some kinds of plant and construct creatures to feel the effects of insanity. The GM should be careful to determine whether the creature’s immunity to mind-affecting effects compensates for an extremely poor Will save and potentially give a bonus on Will saves against sanity damage to such creatures.