I am in the process of planning a campaign but I am not sure how to classify this sickness/disease.

The whole point of the campaign is to rescue a person who has been held captive for about 5 years. He is malnourished and physically and emotionally drained because of all the time spent as captive. So, his body is basically just starting to give up on him.

I guess my question is, how would I go about classifying this "disease", even though I personally don't see it as a disease. I see it as more of a natural, gradual thing that has taken place over a long period of time.

So, I would like your opinion on this. Should I allow a DC saving throw like all the other diseases? Should I only have it so that remove disease is what will stop him from getting worse and then natural things such as better nutrition, a clean living area, and some cure moderate wounds will gradually make him better?

I know you all aren't in my head, but to me the second option just seems better story wise since it is the characters' goals are to get him out and make sure that he lives. I don't want them to just rescue him and then BAM! he's healed.

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    \$\begingroup\$ Welcome to the site! Great first question. Don't hesitate to take the Tour if you have any questions about the site. \$\endgroup\$ – Sandwich Jul 30 '15 at 2:18

Here are the rules:

Starvation and Thirst

Characters might find themselves without food or water and with no means to obtain them. In normal climates, Medium characters need at least a gallon of fluids and about a pound of decent food per day to avoid starvation. (Small characters need half as much.) In very hot climates, characters need two or three times as much water to avoid dehydration.

A character can go without water for 1 day plus a number of hours equal to his Constitution score. After this time, the character must make a Constitution check each hour (DC 10, +1 for each previous check) or take 1d6 points of nonlethal damage. Characters that take an amount of nonlethal damage equal to their total hit points begin to take lethal damage instead.

A character can go without food for 3 days, in growing discomfort. After this time, the character must make a Constitution check each day (DC 10, +1 for each previous check) or take 1d6 points of nonlethal damage. Characters that take an amount of nonlethal damage equal to their total hit points begin to take lethal damage instead.

Characters who have taken nonlethal damage from lack of food or water are fatigued. Nonlethal damage from thirst or starvation cannot be recovered until the character gets food or water, as needed—not even magic that restores hit points heals this damage.

Of course, it doesn't cover malnutrition. You would have to make house rules.

House Rules I would probably do

Use the non-lethal damage, but don't take it as damage. Since he is having some sort of food rather than no food, I would allow the non-lethal damage to accrue. After acquiring the amount of non-lethal damage that would normally result in lethal damage, I would instead give 1 point of Strength and Constitution damage. That will show that he isn't necessarily dying, but withering away. Normal food and rest intake would recover the damage as normal.

If you must use an illness

First off, malnutrition isn't really a disease, so I don't think cure disease would or should have any effect. If someone could cast Cure Disease on the target, there is no reason they couldn't cast Create Food & Water.

I would go with a dysentary, cholera or scurvy type of illness. Malnutrition would more than likely result in getting ill from other sources. There is a spell called Advanced Scurvy. You could model your natural occuring scurvy off of that disease.

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    \$\begingroup\$ I think that Advanced Scurvy is the closest thing to what I want. I think that I would tweak the time it would take to recover from it though since the character started suffering a while back. \$\endgroup\$ – Cookie Jul 30 '15 at 2:53
  • \$\begingroup\$ I like the idea of lowered attribute scores. But shouldn't these also include some mental attribute as well? The question mentions that the NPC isn't just physically drained but emotionally drained too. I think it could be a nice touch. ;) \$\endgroup\$ – Shaamaan Jul 30 '15 at 8:31
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    \$\begingroup\$ I would pick Charisma as the mental stat, if it is wanted. Part of Charisma is drive - and a lack of energy is it's antithesis. For example consider Pathfinder's descriptions of what happens when you hit 0 Charisma. d20pfsrd.com/basics-ability-scores/ability-scores/… \$\endgroup\$ – Isaac Jul 30 '15 at 16:43

That kind of decay is probably best represented by ability damage. He's not "technically" starving, but he's not eating well enough to really support him, right? Poor health = Constitution damage; physical weakness = Strength damage; broken will = Wisdom damage. You could add others too, if you wanted. If he's forgotten how to deal with people like people, that's Charisma damage; if he's got the shakes and lost his coordination, that's Dexterity damage; if he can't concentrate or suffered brain damage, that's Intelligence damage.

Like many effects similar to starvation, it's easy enough to say "This ability damage doesn't heal naturally and can't be healed until the sufferer eats real food, drinks enough clean water, and is no longer tortured for at least X days." However, if there's a healer in the party, they should be able to do something. Maybe once he starts healing naturally, then magical healing will work, too? (Maybe restrict it to half, to jumpstart the process but he'll still get stronger over several days?)

If you want to make it a side quest sort of thing, go for that too. Say he was poisoned by his captors - use the new poison/disease rules from Pathfinder Unchained. He hit the end state forever ago, so neutralize poison won't do it - this poison only has a single rare way to reverse the effects after it's fully taken hold, and bam, side-quest time. Once they get the cure and he would start healing naturally, let the cleric do his thing - it's a quest reward at that point, and the cleric feels like more than a walking potion, it's win/win. If you do use this option, though, still not all of the damage should be from the poison. Make it affect something plot-vital - his memories are locked away until they get the cure or something, if they need something he knows - but the rest can still be healed naturally over time.


One other way to represent malnutrition would be negative levels. These are already not healed by simple hit point restoration, and you can rule the effect to be something along the lines of "1 negative level per 6 months the NPC was imprisoned, and 1 restored level per 2 months he spends recovering." If your PCs have access to magic capable of restoring negative levels, you would probably be breaking verisimilitude by ruling that it doesn't work on malnutrition anyway. That said, you can still apply the mental score decay as a separate effect, and if the captivity changes the NPC's demeanor permanently it's perfectly reasonable that that effect is never reversed by magic.


Create your own Disease.

Since you have this tagged as house rules, I think the best option here would be creating your own disease. It would have some type of strength and dexterity penalty to describe the persons inability to move and lack of exercise over his captivity, since his body is shutting down that would also indicate some kind of constitution penalty as well, as the closer you are to zero constitution, the closer you are to dying.

Once you have that in place you can name your disease, which in this instance I would call "Muscular Atrophy" or "Extreme Malnutrition", name it and stick it onto the NPC you made it for. If you want the Player characters to have the opportunity to cure them, create some kind of condition or quest or secret medicine that the PC's have to acquire to bring the life back into this person who has given up. If you want to make it seem like a life-or-death struggle you can put a time limit on his lifespan so that the PCs have a limited amount of time to get the magical herb/curative spell/delicious wall-chicken that will bring him back from over the edge.

  • \$\begingroup\$ So would this "Extreme Malnutrition" be more of condition rather than a disease? I think the only way to make this happen to get the desired effect is to have it as my house rules. I kind of wanted to stay as close as I could to existing rules, because I have that one person in the group that will challenge me :/ \$\endgroup\$ – Cookie Jul 30 '15 at 2:31
  • \$\begingroup\$ Just state to your players if they refute you that isn't a curable malady because it was caused by years of malnutrition and torture. It isn't a disease caused by bacteria, its a physical condition caused by not eating, not exercising, and torture. Your cleric can't automatically fill a starving emaciated man from the brink of death back to complete health, these things take time. \$\endgroup\$ – Sandwich Jul 30 '15 at 2:38
  • \$\begingroup\$ I think that is most likely what I will do. And yes it would be the cleric that would argue with me. It's like you know this group of Players! \$\endgroup\$ – Cookie Jul 30 '15 at 2:49

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