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In Out of the Abyss, you gain levels of Madness due to certain events. Every time you fail, the Madness level increases, just like Exhaustion level:

  • Level 1 Madness gives you Short term Madness - ~1 minute status effect
  • Level 2 Madness gives you Long term Madness. - ~10 hour status effect
  • Level 3 Madness gives you Indefinite Madness - Permanent Flaw

These can be cured as listed in the DMG, but in Out of the Abyss, when you gain another level of Madness while having level 3 Madness, your Madness level goes back to 1 then you go through all the levels again.

What happens if the player gets into Level 3 Madness more than once, making him get multiple flaws due to Indefinite Madness?

My plan was that, if the flaws stack, I think it will be hard to keep track of all the Flaws so I will just replace the old Flaw with the new one.

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From the description of Madness Levels in Out of the Abyss (p. 21):

If a creature with level 3 madness fails a madness saving throw, its madness level becomes 1. In this way, characters can potentially accumulate multiple forms of madness.

Yes, madness stacks. Since Indefinite Madness is well, indefinite, the flaw is retained when the madness level goes back to 1. In that case, a character would have 1 Short-term, and 1 Indefinite Madness going on.

Keeping track is as simple as writing down each Flaw gained under the old flaws. Though roleplaying multiple indefinite madness might be challenging.

As a sidenote, I wouldn't worry about getting too many stacks of Madness; when I ran the game a while back, only one player got his Madness up to 3, most of my players decided that 1 level was too much.

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  • \$\begingroup\$ Thank god! I was worried if one player might get a LOT of flaws, and keeping track of it slows down the game. My players loves to roleplay so they might actually RP all the flaws they will gain. \$\endgroup\$ – ThatGuyWhoRushesToTheFrontline Sep 28 '18 at 4:09

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