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The Forgotten Realms have vivid descriptions of Ceremorphosis since at least Fiend Folio (2003) for most species, but The Illithiad (1998) before that shows Ceremorphosis of a Roper into a Urophion and deeper insights into the Illithid lifecycle. But that's not where the story began, just the oldest two mentions that are cited in the ceremorphosis article on the FR-Wiki.

The fact that Illithids are sexless and have no sex has been known since Into the Void (1991), while their reproduction via tadpoles was established in the Monstrous Manual (1993):

They are warm-blooded amphibians, and spend the first 10 years of life as tadpoles, swimming in the elder-brain pool until they either die (which most do) or grow into adult illithids. On an irregular basis, adult illithids feed brains to the tadpoles, which do not molest the elder-brain. Illithids are hermaphroditic; each can produce one tadpole twice in its life.1

However, Ceremorphosis, the turning of a humanoid into an Illithid wasn't established in either of those. In Fiend Folio, decades years after the inception of the Illithids, told us how the Illithid lifecyle actually works:

HOW ILLITHIDS MAKE MORE

The mind flayer life cycle is a closely guarded secret that few nonillithids have become privy to. Illithids begin their lives as tiny tadpoles in a briny pool. To reach maturity, the tadpole undergoes a transformative process called ceremorphosis. The process begins when a tadpole is inserted into the brain case of a host human (usually via the ear canal). The tadpole burrows into its victim’s brain, quickly consuming much of the gray matter and replacing the consumed brain with its own squalid tissue. In effect, the tadpole melds with the uneaten lower brain stem of the victim, wiping out all remnants of the personality and spirit of the host, while leaving the physical body alive and ready for habitation. Within days, additional morphological transformations complete the maturation process of an adult illithid.
Ceremorphosis completely replaces the original tissue of the victim with illithid tissue; when the transformation is complete, the original victim is dead, and no spell or power can reverse the process.2

The Illithiad, 5 years prior, did go into quite gruesome details for how the process looks and physical characteristics - in fact, it was a good part of this text that found its way into the Fiend Folio - but no illness stats or progressions. The best you get in this text is that it takes the tadpole three rounds to reach the brain after insertion and one hour after insertion you are dead, your body in coma and destined to stand up as an illithid in 7 days.3

However, as much as I dig, I can't seem to find an official depiction of the process of ceremorphosis as an illness or plague that PCs would need to resist, or as a parasite that could be cured, extracted, or otherwise removed. In fact, it seems that the Fiend Folio and The Illithiad deem ceromorphosis as rendering the character unplayable minutes after infection with a tadpole.

Is there an official rules text in any edition of D&D (but most preferably 3.5th) on how to handle the steps of Ceremorphosis?


1 - Doug Stewart: Monstrous Manual, Lake Geneva (1993), p. 251.
2 - Eric Cagle, et. al.: Fiend Folio. Renton (2003), pp. 90.
3 - Bruce R. Cordell: The Illithiad. Lake Geneva (1998), p. 11-12.

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  • \$\begingroup\$ "In Fiend Folio [2003], 10 years after the inception of the Illithids..." -- Illithids are present by that name in Gygax's adventure Descent into the Depths of the Earth (1978). They first appeared as Mind Flayers in The Strategic Review #1 (1975). \$\endgroup\$ Sep 21, 2023 at 23:29
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    \$\begingroup\$ @DanielR.Collins fixed to decades. \$\endgroup\$
    – Trish
    Sep 21, 2023 at 23:55
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    \$\begingroup\$ It’s a little unclear why you refer to the Forgotten Realms here. So far as I know, none of the sources discussed here are specific to the Realms… \$\endgroup\$
    – KRyan
    Sep 22, 2023 at 5:31

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Lords of Madness has one

Ceremorphosis isn’t entirely consistent from source to source—duration, suitable hosts, etc., tend to vary. But at least one book did describe the experience in some mechanical terms, including how to save someone from it—and conveniently, it’s the primary 3.5e source on illithids.

Over a period of several days, the tadpole burrows into the host brain, consuming gray matter and gaining body mass in a nearly equal ratio. When the process is complete, the victim’s brain is completely replaced by the tadpole’s bloated tissue. The tadpole is neurologically melded onto what remains of the lower brain stem and assumes complete control of the body’s nervous system. The victim dies irrevocably, but the body lives on with a parasite serving as its brain.

Victims have been rescued from this horrid fate, but only if help arrives quickly. A victim is permanently drained of 1 point of Intelligence, Wisdom, Charisma, and Dexterity every hour after tadpole insertion. When any one ability is reduced to 0, the victim’s psychic essence is destroyed and replaced by the tadpole’s awakening mind. Before that point is reached, restoration can reinstate lost ability points but won’t kill the tadpole, so damage keeps accruing. The only sure way to save the victim is to kill the tadpole. The tadpole itself is very easy to kill (automatic kill with a coup de grace), but its location inside the victim’s head is a serious complicating factor. Spells such as cure disease and remove curse have no effect; only a heal spell can save a victim undergoing ceremorphosis.

In most cases, the only way to guarantee the tadpole is slain is to crush or incinerate the victim’s head. At that point, resurrection, true resurrection, or raise dead come into play. Raise dead alone is of no avail if the victim’s head was destroyed in the process of killing the tadpole.

The process of ceremorphosis takes a week to complete but it cannot be reversed after any of the victim’s ability scores are reduced to 0. From that point, no means can bring the victim back short of a miracle.

(Lords of Madness, pg. 62-63)

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  • \$\begingroup\$ Steve Winter et. al.: Lords of Madness, Renton (2005) \$\endgroup\$
    – Trish
    Sep 21, 2023 at 14:38
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    \$\begingroup\$ Wait, no means can bring the victim back short of miracle? I would think Clone and Resurrection both work, since ceremorphosis only destroys the brain, doing nothing to the soul. Okay, Resurrection would be a bit fiddly if the illithid body doesn't count as the victim's body. \$\endgroup\$
    – Phoenices
    Sep 21, 2023 at 16:28
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    \$\begingroup\$ @Phoenices Clone should work, yeah. Resurrection likely would not because ceremorphosis involves the illithid completely consuming the host body and replacing it with its own tissue—the body provides nutrients, scaffolding, and materials, but nothing is left of it once the process is done. (Or, at least, some sources suggest that, anyway.) \$\endgroup\$
    – KRyan
    Sep 21, 2023 at 17:10
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    \$\begingroup\$ @Phoenices Ship of Theseus presumes replacements with identical parts; ceremorphosis is definitely making replacements with very-different parts. \$\endgroup\$
    – KRyan
    Sep 21, 2023 at 18:50
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    \$\begingroup\$ @MichaelRichardson Honestly, this section of Lords of Madness is… not great. It strongly reads as if it was written by two different people who weren’t communicating with one another well. So, shrug. \$\endgroup\$
    – KRyan
    Sep 22, 2023 at 14:31

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