Insanity: Umbra Malady Condition in Erenel | World Anvil

Insanity: Umbra Malady

Insanity rules for D&D 5E

The choking mystery of meaning will haunt you through scrambled dreams, and torment you with hints of forgotten memories and the pain of loss. You reach out in the nightmare to find a symbol of previous days of joy to light your way back… but you will fail. You have fallen into the clutches of repression. The Null who hide in plain sight will not relent.
Umbra Malady exists outside the realm of sanity, acting like splinters in your soul if you expose yourself to the Void. Hearing or reading the ancient language Umbra is similar to opening a door for Umbra Malady to invade your conscience. Ancient beings known only as Null, murmur from beyond the veil to anyone who will listen. Things from beyond hear the call and echo into existence using the Umbra Malady illness as a conduit to unhinge the mind and bring upon insanity in a creature.


Exposure to a Void presence or Null unhinges the mind, wreaking havoc on the most steeled of will. Some creature special abilities and environmental hazards can lead to a special condition called Insanity. Insanity is measured in six levels, similar to the exhaustion condition. An effect can give a creature one or more levels of insanity, as specified in the description of the effect.   If an already afflicted creature suffers from another effect that causes insanity, its current level of insanity increases by the amount specified in the effect's description.   A creature suffers the effect of its current level of insanity as well as all lower levels. For example, a creature suffering level 2 insanity can not benefit from the help action, has disadvantage on all Charisma checks, disadvantage on Wisdom (perception) checks, and their passive perception reduced by 5.

Insanity Strength DCs

Insanity effects have differing save DCs, which represent its power. The save DC typically equals the source of insanity, but the DM may modify the DC to what they deem appropriate.   The DC to avoid an insanity effect will equal 10 + half of the creature's challenge rating. An example would be a CR 4 creature would have a DC of 12.


An effect that removes insanity reduces its level as specified in the effect's description, with all insanity effects ending if a creature's insanity level is reduced below 1. High level spells that remove levels of exhaustion may also remove levels of insanity, such as Greater Restoration.   Finishing a long rest reduces a creature's insanity level by 1, provided that the creature also was able to rest correctly and not haunted by their fractured mind. To perform a successful long rest, the creature must make a Wisdom saving throw equal to their current insanity level DC, as shown in the insanity effects table below. On failure, the long rest is unsuccessful as whispers haunt the creature, keeping them awake all night. Standard exhaustion rules occur for creatures who do not rest.

Religious Ceremonies

When an unfortunate soul is afflicted with insanity, there is not much time before the afflicted is lost to madness. If the afflicted has not yet passed into insanity level four, a religious ceremony upon sanctified grounds by a knowledgable priest can silence the whispers.   Many religious sects will help remove insanity with the most common being the followers of Asanna, Lady of the Land, Luniwyn, the Silver Maiden and Rezmir, of Light and Law. The service is performed for a fee dependant upon the level of insanity as outlined below.
  • Level 1: 50 gp
  • Level 2: 250 gp
  • Level 3: 1,000 gp
  • Level 4: 2,500 gp


Certain magical items and consumables can aid in dealing with insanity by providing Insanity Resistance. Insanity resistance gives advantage on saving throws against special abilities and environmental hazards, which increase insanity levels. Long rest DCs do not benefit in this way from insanity resistance.   Instead, when attempting to make a long rest with an insanity level, the Long Rest DC is treated as one level lower than the current level. The Long Rest DC is unable to fall below 10. For example, a creature with Insanity Resistance who has level 2 insanity would make a Long Rest DC of 10.

Important Reminder

It is important to note that the insanity ruleset is not intended to be a realistic representation of mental illness but a super natural condition that adds depth and thematics to your game.

Mental illness is a real affliction many suffer from, and it is essential that as a DM, you are aware and considerate of your players. Please make sure they are comfortable using this system in your games.
Chronic, Acquired
Accepting Umbra Malady
Umbra Malady offers power and knowledge, for it touches all places and times, but everything offered comes with a price. Only the desperate or foolish willingly accept Umbra Malady. Others attempt to study The Null in what they believe is a protected environment, hoping to one day silence the whispers.   Regardless of the reasoning, Insight can be gained and a rule set will be explored this month. Stay tuned for Insight!
The Null
Generic article | Apr 12, 2022

The mere presence of these other worldly organisms is enough to splinter the mind.

by Dean Spencer

Insanity Effects Table

Level Effect Long Rest DC Additional Effects
1 No longer benefit from the Help Action. Disadvantage on Charisma checks and saving throws 10 Paranoia. Your skin becomes deathly pale.
2 Passive Perception decreases by 5. Disadvantage on Wisdom
(perception) checks
12 Hallucinations begin. Your eye color becomes black and your pupils enlarge.
3 Dexterity modifier removed from Armor Class. Speed halved if wearing heavy armor. 14 Fear. Your eye sockets and eyes grow larger. Splitting headaches are constant.
4 No longer perform any bonus actions or reactions 16 Spine hunches slightly. You begin to understand the whispers and their dogma.
5 No longer benefit from proficiency bonuses 18 Physical frame grows thin and frail. You feel nauseated and ill unless you listen intently to the whispers.
6 The Dungeon Master now controls the character and attacks
anyone within sight while conscious
20 Madness and hysteria. Your skin rapidly blisters and burns when
exposed to sunlight.


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