Dungeons & Dragons Online

Diseases That Make Players Care

Hello there!

A while ago I made a post on this sub about how to make "dynamic diseases". Since then I've iterated and tested these ideas and mechanics and developed something new I'm happy with.

Today, I'm here to share a full PDF on my Patreon with the updated guidelines, along with some new diseases I've made as part of the update (the Patreon is of course is 100% public).

Here are some examples of the disease you can create, using the guidelines I've created:  



Supposedly created by an ancient Elder Oblex or an experiment gone wrong, Headrattle is a disease that consumes and replaces memories, causing the infected to either lose or gain new memories, or both.

It can affect any creature, but the extent is contextual. Losing your memories, or gaining the memories of others; as if they were your own can be very taxing on an individual, driving them to the brink of their sanity.

This is a rare disease, with little study (a prime target for curious minds). It's unclear how it can spread, and this is key to the fear surrounding the disease.

Themes & World Style

Headrattle is best used in games with horror or intrigue. The mystery around the origin, the spreading and even how it can manifest makes for a great detective-like approach.

Mechanics & Treatment

It is important to keep the mystery with this illness, so it should be noted to use the mechanics sparingly but with purpose. The core mechanic with Headrattle is that it spreads through dreams. If an infected has a dream within 120 feet of anothe person, there is a 25% chance they will contract the disease.

The illness begins by the newly infected remembering the dream of the person who gave it to them. If you want to use this on your players, the use of whispers or separating information would work well here.

The only treatment or cure, is to use a sample of the original Oblex along with an alchemist kit and a week of work to try make a remedy. This knowledge will have to be learned by the players from someone else (a notebook, a laboratory or an NPC, for example).


Creating intrigue is the core of Headrattle and therefore our hooks will reflect this. However, you can also simply use this in rumours from another town for worldbuilding purposes.


1More and more students from the Mages University in the city are becoming erratic and some have gone uncontrollable with magical outbursts. Why are they losing their minds?
2An explosion in a major research facility in the city has caused an entire district to shutdown. Ivar, the local scavenger wants you to go in to grab anything of value. Inside however, might have some things still lurking.
3Every night for the past week you've been having new dreams about locations you've yet to visit. Things in the dreams seem to come true. Last night you dreamt of a terrorist attack being planned in the city.
4People have been going missing lately, and turning up a few weeks later as shells of their former selves. They remember nothing.. they don't even know who they are? Who did this to them?
5The city guard are aggressively detaining anyone who exhibits signs of insanity in public. An ally of yours has been mistakenly arrested. Why are people going insane and why is the city trying to hide it?
6She comes to you at night, as whispers in your dreams. She promises you everything in time, but for a small price. All she wants is you to dream of her name; Avalune. You find others a few days later, screaming Avalune in public; one preaching in her name, another clutching their head in pain, another handing out flyers for her church.




When asked what he would give up, Saekron chose humanity. The place of power would take his gift and then give unto him a twisted reward, one that would see him ascend beyond mere mortal. As his own eyes grew sallow, his blood becoming fire in his veins, a whisper caught his ear; "You cannot give that you don't have"



Dreadrite is one part disease, one part curse and one part boon. A twisted organisation have learned that dormant places of power exist throughout the world, leylines and idols containing massive amounts of unexplored magic. These almost sentient powers twist mortals who give their energy into them; sometimes taking their lives, other times ascending them into more than mortal. Dreadrite is a condition that happens when someone undergoes a ritual to 'give up' something of value in return for power.

Themes & World Style

Power is a major theme that can work with Dreadrite.Perhaps a villain went through the rites, and now your players are faced with a choice; do they give up something in order to defeat a tyrant?

Another element of this are the places of power themselves. This is an aspect that can fit into most settings; but consider why exactly these places have such importance; something too powerful for normal minds to comprehend.

Mechanics & Treatment

Dreadrite can only be performed if all conditions are met. Something of value must be given up, it must be done in a place of power. In order to discover the type of sacrifice requires, players must make an arcana check to commune with the place of power. The response will be like energy, almost painfully vague or misleading.

In terms of benefits gained from Dreadrite, a lot of this will depend on the state of the game. DMs should consider the power level of features they plan to give, along with the pain of their sacrifice.

Some examples could be giving them a 1st level spell they can cast once per long rest or granting them a blessing or boon from the DMG. This is the element that makes Dreadrite such a powerful tool to be used to make interesting stories.

d6Dreadrite Sacrifices
1Blood of your kin (amount up to DM's discretion)
2A connection to your patron, deity or higher power.
3Your sanity. Roll on the indefinite madness table) (DMG pg. 260)
4Your knowledge. Lose memories equal to half your level rounded down. These can be random spells known, memories of NPCs, major events or the last 1d4 days.
5Your health (roll your class' hit die, and reduce your maximum HP by this amount permanently).
6Your wealth. Relinquish all assets, and give up half your gold.


While the actual condition itself could be an entire story on its own, I see no harm in including some fun hooks and complications for when Dreadrite is injected into a game. A key thing to remember however, is that if you don't want this to be a central focus, this can always be optional backstory for a major villain or an illicit organisation in your world.

1A secret organisation has been forcing people into making a Dreadrite. What do they gain?
2Not enough of a sacrifice was given for a Dreadrite, resulting in the place of power taking more than the person intended. How much have the lost?
3The place of power was corrupted by some outside force, resulting in twisted gifts.
4For a brief moment during the Dreadrite, the individual communes with a higher power.
5The energy within the place of power caused an outburst during the rites and begins to collapse.
6You find someone who has just undertaken the Dreadrite. They lay still and you're unsure if they're alive or have received the gifts.





Known as Boilant Disease or Arcanobane to some, Sventurum is a type of fungal infection that causes numerous growth-like boils to spread across the body. When interacting with any magical charge, the boils light a bright blue, and become unstable; causing expolsions or other magical discharges to occur.

It can only be contracted if the fungus enters the body, whether through injection or ingestion.

Themes & World Style

Sventurum is best used in worlds where a conflict is about to start or ongoing. Potentially used as a bioweapon, it can make for some interesting terror-like attacks in major cities.

It also is very interesting when the use of magic is a major theme in the world, and can help reshape thoughts around the arcane.

Mechanics & Treatment

Upon ingesting the fungus, a constitution saving throw would be appropriate to resist the infection. On a fail, a growth will begin to grow and will be active after 2d4 days. Once complete, roll a d6 after every long rest. On a 5 or 6, another growth will try to grow, starting again with another constitution saving throw.

Every time the individual has magic passing through their body they must make difficult wisdom saving throw to try contain the surge. Make a check for each growth the creature has. On a fail, roll on the Arcane Discharge table. Please note that all these DCs do depend on the DMs discretion. It should be difficult for a player to contract this illness, and even more so for it to progress. Also, for narrative reasons if creatures don't have the will to resist, they will likely explode from the energy.

Treatment is fairly simple, using a non-magical solution. Perhaps a rare leech can absorb the fungus, or a certain herb like Emberblossom can burn through the infection.


Sventurum in itself can be used as an inciting incident in a major population hub. Suddenly, an entire district of a city begins to explode, creating a chain reaction of magical disaster. The players will need to go into the deadzone to retrieve something, or find out more information.

Alternatively, the major hook could be preventing this scenario from happening. This would create more of an intrigue style adventure where our heroes must race against the clock to prevent a catastrophic event.

Another option could simply be that the players are tasked with delivering, and detonating this magical terror attack (while not being told the truth). They may have to confront their involvement, choosing disaster or gold. Aside from war related uses, Sventurum has potential to create an interesting villain, who researched its properties by exposing others to it, or even was a test subject themselves.

d10Arcane Discharge
1Do 1d6 fire damage per level in a 20 foot radius
2You cast 1d2 1st level Magic Missile spells at random creatures within range (including self).
3All casters within 30 feet of you make a wisdom saving throw (DC15). On a fail they lose one of their lowest available spell slots. If you are a caster, you gain the lost spell slots (cannot exceed your maximum).
4You cast Dissonant Whispers at a random creature within range (including self).
5Gust of Wind casts centred on you in an upward direction.
6You cast Detect Thoughts on all creatures within 30 feet. All those who fail the save are aware of all the common thoughts of the failures between them all.
7You are transported to a random place (location, plane, height, etc; DMs discretion) until the end of you next turn, after which time you return to the space you previously occupied or the nearest unoccupied space if that space is occupied.
8Your current hit points are halved, and distributed evenly (rounding down) to all creatures within 20 feet. If no creatures are nearby the energy crystalises into a stone that you cannot touch without being burnt.
9An Archanoimage of pure magic spawns nearby and immediately tries to possess you (Consider it a reskinned Ghost who's first action of surprise is the Possession action. After that enter into normal initiative order.
10Grow another growth that instantly matures. Make another saving throw against arcane discharge.



Well if you made it this far I hope you enjoyed some ideas I've been playing around with. Over the next few weeks I'll try to make more PDFs like this, with new (and some updates of old) content. You can find the first post, and all future ones on the public Patreon.


Thanks for reading,



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