I am playing DnD since 3e and recently my fellas and I bought the 5e books. I already DM them in some eldritch-horror style campaigns.

Back in the days of 3 and 3.5, characters used to have sanity points and a system that allowed them to roll a d% to see if they pass or fail a sanity check. This would result in players potentially losing sanity points.

With 5e, I cannot understand how someone can go mad, crazy, etc since there is no sanity point system.

So do I just roleplay their way into madness without keeping track of who's actually close to being mad, crazy, etc or am I missing something?

Thank you in advance for your replies.


There are optional rules that add sanity as an ability score. They can be found in the DMG on pages 264-5. The rules for madness start on page 258 and define short-term, long-term and indefinite madnesses you can impose on the players. The rules for fear and horror on page 266 might also interest you.

  • \$\begingroup\$ Ok so there is not some sanity pool from which points get deducted and player can suffer some permanent illness. Thank you for your clarity. Actually pages 256, 265 and 266 helped a lot to understand that instead of an intelligence or wisdom check, I'll just do sanity. and play accordingly with short-term, long-term, or indefinite madness. \$\endgroup\$ – Drunken Commoner Mar 13 '18 at 22:01

Another option using standard Conditions and Mechanics

If you don't want to use the Optional Sanity score in the DMG as suggested by Szega and Kviiri, you still have access to some options in the PHB that you could tailor to your game.


Fear is a big portion of the horror setting, and you could utilize Wisdom checks for the Frightened condition. It doesn't have any variance in level of fright, but that's where you could introduce Exhaustion mechanics.


For any given number of hours/days/weeks that someone remains Frightened, they could suffer another level of exhaustion due to their state of Fright. This provides a means to add a mechanic beyond the Frightened Condition, and also allow for spells like Greater Restoration to help them get over it and mitigate their plight of fright.


Variant sanity rules in the DMG

Dungeon Master's Guide has optional rules for sanity checks, on pages 265 and 266. The rule is that Sanity is a new ability score (along with Strength, Dexterity, etc) and actions taxing the character's sanity are resolved by a Sanity saving throw.

A failed Sanity saving throw results in a semi-permanent loss of a single point of Sanity and suffering a mental illness described in DMG chapter 8.


The Out of the Abyss module (spoiler below)

made frequent use of a system for madness rolls and saves, since the characters face a lot of demons. By that point, though, the various insanities contracted are too easily cured through Greater Restoration or other magics.

That's probably the closest you'll get from official sources, although for a campaign that features real threats to the sanity of the characters, I think you'd still need to homebrew something a lot more detailed.

  • \$\begingroup\$ Are the mechanics in your spoiler identical to the DMG option suggested? Never played that module and don't have access to see if they're the same. \$\endgroup\$ – NautArch Mar 13 '18 at 19:24
  • \$\begingroup\$ Phil - it may be worthwhile to list the page number on the module with that info. \$\endgroup\$ – NautArch Mar 13 '18 at 19:35
  • \$\begingroup\$ @NautArch: There are two very different mechanics in the DMG: madness and sanity. The mechanic described here builds on the former a small bit, but is largely similar. \$\endgroup\$ – Rubiksmoose Mar 13 '18 at 19:37
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    \$\begingroup\$ I don't know the exact mechanic in Out of the Abyss, nor the page number, since I do not have that module. I played in it when someone else was running it, and intentionally did not obtain and read the module, as my character would not have known that stuff. I just know that there were some mechanisms in there relating to that subject, and mentioned it so that the questioner could look into it for himself and see if that helped him in his question. \$\endgroup\$ – Phil Boncer Mar 13 '18 at 20:09

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