Combat Stress

So this came about from reading through the back catalog of Alexis Smolensk’s Tao of D&D. (that’s where I’ve been since before the last post, and I’m still not through it all)  The guy is dedicated, experienced, and does not suffer fools.  Go read everything he’s written, buy his books, improve your game.  Seriously, don’t waste your time anywhere else, the Tao is the grand-master of DMs.

Anyhow, in one of his posts (entitled Medicine, from 2013) he mentioned that trauma rarely leaves a lasting mark on PCs, where any real person attacked out of the darkness would carry that terror, that trauma with them for a long while.  Presented below is my attempt to codify that trauma and apply it to characters in a meaningful way, based largely upon current research about PTSD but modified a bit to flow into a usable system for gaming.

Traumatic Stress:  After any critical hit, wounding strike, injury that takes the character into negative hit points, or witnessing a comrade die in combat, a wisdom check (rolling at or under the character’s Wisdom score on a d20) is made.  Since those who are battle-hardened are less likely to be affected by sights or experiences of the brutality that occurs in combat through long exposure to such, modify the d20 roll downward per the character’s Base Attack Bonus.  If the check fails, the character gains 1d4 Trauma Points.  These are then applied by rolling on the Stress table (below).  Each Stress symptom can have up to 4 points, and the more points a symptom has, the more severe the effects (described below).

Re-Experiencing Avoidance and Numbing Anxiety and Emotional Arousal
1 Upsetting Memories 6 Avoidance 11 Insomnia
2 Flashbacks 7 Memory Loss 12 Anger
3 Nightmares 8 Disinterest 13 Distraction
4 Emotional Distress at reminders 9 Detachment 14 Hypervigilance
5 Physical Reaction to reminders 10 Limited Future 15 Startling

These points will “heal” one every 5-(Wis modifier) weeks if another successful Wisdom check is made (this time unmodified by BAB).  A character receiving counseling (at least 4 hours a week) would be treated as having a Wisdom score of two higher for the purpose of this check, and the interval between checks would be decreased accordingly as well, if the counseling was continuous during that time.  However, this benefit does not apply if additional trauma points are gained in the interval.


Upsetting Memories – Upsetting memories are unwelcome replays of traumatic events that intrude on normal thought, but do not unduly interfere with normal action.  Physical work may be slowed somewhat, but speech becomes stilted, and the sufferer is unable to hold a meaningful conversation for some 5 – 20 minutes while the memories are intruding and being pushed away.  Affects the sufferer according to the following schedule.  Roll a d6 each day, an event occurs that day if the roll is lower or equal to the number of trauma points accumulated in this stress symptom: (sorry about the table being less than Table-ey, WordPress doesn’t handle tab stops very well)

Trauma Points Roll
1 1 in 6
2 2 in 6
3 3 in 6
4 4 in 6

Flashbacks – flashbacks are vivid rememberings of traumatic events that seem real and cohesive to the sufferer. When suffering a flashback, no communication or meaningful action is possible. The victim is wholly under the impression that they are once again experiencing the traumatic event. The sufferer will cry out, thrash, or become still and unresponsive for the duration of the flashback. These episodes can last from 1 to 10 minutes, on the same chance as Upsetting Memories, based on the number of trauma points in this category.

Nightmares – nightmares are terrifying dreams of traumatic events, either of the event itself or of a similar, imagined event.  Those suffering from nightmares will become restless during sleep, possibly cry out, strike at the air, or other physical responses.  After a nightmare, the sufferer will awake in terror and remain awake for 10 to 60 minutes.  Nightmares may occur at the frequency given on the table above.

Emotional Distress at Reminders of Trauma – After suffering a reminder of a traumatic event (be it flashback, nightmare, intrusive memories, or external reminders), the victim will endure emotional distress because of these reminders.  This may manifest as a refusal to participate in normal interactions, weeping, isolation, manic hysteria, or angry outbursts.  The severity and duration of these episodes is dependent on the number of trauma points assigned to this category.  After suffering Upsetting Memories, Flashbacks, or Nightmares, the sufferer must make a Wisdom check at -2, -4, -6 or -8 (for 1, 2, 3, or 4 points in this category).  The duration of the abnormal emotional response is 5-10, 10-15, 15-20, or 20-30 minutes depending on the points in this category.

Physical Reaction to Reminders of Trauma – After suffering a reminder of a traumatic event (be it flashback, nightmare, intrusive memories, or external reminders), the victim will endure physical effects relating to the trauma experienced.  This may manifest as nausea/vomiting, severe pain in an old wound, headache/migrane, or racing heart/labored breathing.  The severity and duration of these episodes is dependent on the number of trauma points assigned to this category.  After suffering Upsetting Memories, Flashbacks, or Nightmares, the sufferer must make a Wisdom check at -2, -4, -6 or -8 (for 1, 2, 3, or 4 points in this category).  The duration of the abnormal emotional response is 5-10, 10-15, 15-20, or 20-30 minutes depending on the points in this category.

Avoidance and Numbing

Avoidance – Sufferers will subconsciously avoid those things which share a resemblance to the events or characters of a traumatic event.  These may include locations reminiscent of the location where the trauma occurred, persons resembling the assailant, the weapons or implements used during the trauma, or more esoteric things such as thoughts that occurred prior to the trauma, or decisions that lead to the trauma occurring.  The degree to which these things are avoided is dependent on the number of trauma points in this category.  For example: if Adventurer A was attacked in a dungeon hallway by an orc wielding a pickaxe and suffered a critical hit from said orc, Adventurer A might avoid any of the specific characteristics of that event.  If he had 1 point in Avoidance, he may unconsciously avoid dark, underground passages that are carved from living stone.  If he had 2 points, he may avoid dark hallways of any kind.  3 points, any hallways or dark spaces.  4 points, any underground structure at all, or any hallway.  A wisdom check may be made (at a -2, -4, -6, or -8) to overcome this avoidance and enter/interact with the avoided stimulus.

Memory Loss – A common coping mechanism of sentient creatures is to forget important aspects of a traumatic situation.  Depending on the points in this category, the amount forgotten may be a few seconds to the entire day.  This is not normally problematic, but may become an issue if the specific stimulus that triggers other responses cannot be determined because of the loss of memory of the traumatic event.

Disinterest – The sufferer may become disinterested in things he/she once enjoyed, such as food, dancing, card playing, or any or all other activities, depending on the severity of the affliction.  At 1 point, the sufferer may be less enthusiastic about a favorite activity. At 2 points generally ambivalent to several favorite pursuits.  At 3 points, disinterested in all but a few activities. At 4 points, extremely uninterested in any activity at all.

Detachment – Trauma will cause the sufferer to withdraw from relationships and social activities and become numbed to emotions.  At one point the sufferer will be less fervent in keeping promises and fulfilling obligations; at two points feeling will be dulled, so happy or sad events will seem less significant than to others; at three points other people will not seem to matter much, and promises will be forgotten due to disinterest; and at four points only extremely affecting events will be reacted to with any emotion at all, and then only minor changes in emotional response will occur.

Limited Future – Positive outcomes in the future will seem extremely unlikely.  This will result in a lack of meaningful planning, ambition, and enthusiasm for life.  1 point signifies a lack of belief in overall, long-term success of major projects.  2 points indicates significant life events will be believed to become impossible (getting married, having children).  3 points indicate a lack of belief in career success, leading to poor or absent risk management planning.  4 points indicates a belief that any plan undertaken is doomed to failure, so nothing is worth trying.

Anxiety and Emotional Arousal

Insomnia – Sufferers will not be able to sleep for long stretches of time, or will have fitful, unrestful sleep.  1 point will result in only 6-7 hours of sleep on a 1 in 6 chance per night.  2 points will result in a max of 5-6 hours on a 2 in six chance per night.  3 points means 4-5 hours max at a 3 in 6 chance per night. 4 points means a max of 3-4 hours of sleep at a 4 in 6 chance per night, not counting time spent awake due to Nightmares.

Anger  – Perhaps the most visible symptom of traumatic stress, one or more points in Anger will make it more likely that the sufferer will have random outbursts of irrational anger, sometimes at reminders of traumatic events, sometimes in stressful situations that are completely unrelated.  1 point indicates that some reminder of the trauma will result in a burst of irrational anger on a chance of 1 in 10.  2 points will result in anger in any stressful situation on a chance of 2 in 10, or 3 in 10 where a specific reminder of the trauma is involved.  3 points will mean a chance of irrational anger for no reason 1 in 10 days, overreaction to stress at 4 in 10, or with reminder at 5 in 10.  4 points indicates bursts of irrational anger  may occur on a 1 in 6 chance every hour, stress reactions at 5 in 10, and with a reminder of 7 in 10.  Intoxication would increase chances in every case by 2.

Distraction – Trauma preoccupation will result in a character being easily distracted or forgetful and make it harder to complete or perform tasks that require time and attention to complete.  1 point will increase the time to complete such tasks by 25%, (thus and 8 hour task would take 10 hours).  2 points by 50%; 3 points by 75% and 4 points by 100%.

Hypervigilance  – In hypervigilance, there is a perpetual scanning of the environment to search for sights, sounds, people, behaviors, smells, or anything else that is reminiscent of threat or trauma. The individual is placed on high alert in order to be certain danger is not near. Hypervigilance can lead to a variety of obsessive behavior patterns, as well as producing difficulties with social interaction and relationships. Below is the table describing the chance of violent overreaction to which stimuli per point of trauma.

1 1 in 10 persons approaching quickly, brandishing small objects
2 3 in 10 swift changes in position of persons being interacted with, loud noises nearby
3 5 in 10 strangers appearing suddenly, loud noises far away, rushing crowds
4 7 in 10 any sudden movement, loud noise, or unpleasant demeanor

Startling – similar to Hypervigilance, but with a fear reaction instead of aggressive reaction. Duration of incomprehensibility and to what stimuli (see Hypervigilance table for stimuli) increase with points. 1 point indicates 1d4 minutes of reaction to very specific stimuli, generally relating to the original trauma. 2 points indicate 2d4 minutes to more general stimuli, which may or may not relate to the original trauma. 3 points indicate 2d6 minutes reaction to fairly common stimuli. 4 points indicate 3d6 minutes reaction to broad stimuli.

So, there it is.  It may not be as clear as I think it is, so if you have any questions, feel free to ask and I will clarify as necessary.

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