By Beren Goguen

Most DMs rarely (if ever) use the rules for Exhaustion in 5E D&D. Probably because it’s just not fun.

Dealing with Exhaustion as a player sucks, especially when it goes past level one (disadvantage on ability checks) to level two (speed halved), which is a major drag for any mobile, melee-based character.

Then we have level three: disadvantage on attacks and saving throws.

That’s downright punishing.

And these effects stack! Yikes.

Clearly the designers didn’t thoroughly playtest this mechanic in Fifth Edition D&D (or the testers were just gluttons for punishment). Now, some DMs might argue that Exhaustion is supposed to be brutal and used sparingly to ramp up the challenge at higher levels of play. However, Exhaustion is getting a major overhaul in One DnD, which leads us to believe the designers now consider the 5E rules to be overly punitive.

Although we like the straightforward rules for Exhaustion v2, we also feel this update goes a little too far in the opposite direction.

It’s just a bit… underwhelming, especially if you enjoy gritty, gutsy grimdark settings.

So we made an alternative.

Introducing the Poise System

In our upcoming campaign setting, Shadow Over Elidir, we decided to ditch Exhaustion altogether in favor of a new mechanic: Poise.

We’re also updating the somewhat outdated rules for Madness and introducing a new mechanic: Mania.

These mechanics now work in tandem to ramp up the challenge and gritty realism.

Poise: Losing Composure Can Be Deadly

Unlike Exhaustion, which can build up over the course of a game, your Poise starts out full and degrades over time.

While Hit Points represent a character’s physical health and vigor, Poise represents a combination of mental and physical composure, which deteriorate under difficult circumstances such as:

A devastating blow and/or major loss of hit points
Critical failure (rolling a 1)
Falling more than 10 feet
Being attacked by a horrific creature you've never seen before
Stumbling upon a mutilated corpse or other gruesome scene
Witnessing something particularly horrifying
Being afflicted with strange nightmares
Etc.

When fully rested and recuperated, a character’s Poise is equal to their Constitution or Wisdom score (whichever is higher) up to a maximum of 15 but no lower than 10. As Poise drops, consult the Poise Degradation Table. Higher Poise provides more buffer against mental and physical deterioration.

The DM decides when an event or action might impact Poise, and whether or not the player can make a saving throw (INT or WIS for mental stress or CON for physical stress) to avoid Poise loss. In most cases, Poise drops one point at a time, but in dire circumstances, it might drop by two or three points, at the DM’s discretion.

Poise can be recovered in three ways:

Taking a Short Rest increases your Poise by 1.
Taking a Long Rest increases your Poise by 1D4 +1
A spell. Greater Restoration will completely restore Poise, while Lesser Restoration will restore Poise by 1D4 +1 (same as a long rest). Healing spells may also restore some Poise, at the DM’s discretion.

Mania and Madness: A Fragile Mind Can Be Broken

When a character’s Poise drops below a certain threshold (indicated by the color gradations in the Poise Degradation Table), their mental state will change. When this occurs, the player must make a Mania Check (WIS saving throw) against the Mania Check DC in the table. The DM may also ask players to make a Mania Check when facing an extremely stressful event, even if their mental state has not changed.

Failing a Mania Check results in Momentary Mania (for mild or moderate stress) or Long-Term Mania (for extreme stress). It also breaks your concentration. Consult the Mania Tables to determine what effects occur.

A character will suffer Indefinite Mania (Madness) under the following circumstances:

Their Poise drops to zero (but they recover)
They are forced to make death saves (but recover)
They fail more than three mania checks before taking a long rest

Poise Degradation Table

Mania Tables

There are three types of mania: Momentary, Long-Term, and Indefinite.

When your character gains a mania, roll a D100 to determine what effect your character will suffer from.

Note: A character may only suffer from one of each type of mania concurrently. For example, if a character already suffers from extended mania and would gain another extended mania, the new extended mania effect replaces the older effect.

Momentary Mania

Duration: Unless specified, the effect lasts one turn.

01–10 (Shell Shocked): You withdraw into your mind, sitting down on the ground, rocking back and forth. Become incapacitated until the end of your next turn. Take 1D4 psychic damage.
11–20 (Subdued): You’ve had your fill of violence and death. You can not take the attack action until the end of your next turn.
21–30 (Demented): Your grip on reality starts to break, causing you to scream or laugh. Drop any weapons or items you are holding, then use all your movement to move in a random direction.
31–40 (Panicked): You immediately become frightened of the closest enemy (or NPC or ally, if there are no enemies) and must use your next action to Dash away from the source of your fear.
41–50 (Cracked): You start to babble and mutter, preventing you from normal speech. You cannot cast spells with a verbal (V) component until the end of your next turn.
51–60 (Maniacal): Nothing seems real unless you are experiencing pain. You inflict 1d6 of self-damage (must be of a type you are not resistant to).
61–70 (Drained): It suddenly feels as though you carry an immense weight. You cannot take any move or attack actions until the end of your next turn.
71–80 (Unglued): You begin to eat dirt, mud, grass, or some other non-edible material nearby, gorging yourself until you become sick and realize you’ve utterly lost your mind. Take 2D4 psychic damage.
81–90 (Enraged): Use your next action to make a reckless unarmed attack (at advantage) against the closest enemy (or NPC or ally, if there are no enemies). If you attack an enemy, that enemy’s next attack against you is made with advantage.
91–100 (Crazed): Your skin crawls. You use your next action to remove all your equipment and clothing, including armor, putting everything into a pile on the ground.

Extended Mania

Duration: Effect lasts until you have taken a long rest.

Note: Certain manias have the “re-occurring” feature. Roll 2D20 to determine how many minutes (actual time, not game time) pass before your character experiences another episode. Roll again after each episode.

01–10 (Mad): You feel compelled to repeat a specific compulsive activity over and over, such as praying, counting your money, sharpening your sword, etc. Suffer -2 CHA.
11–20 (Raving): You periodically break from reality, experiencing auditory or visual hallucinations, which cause you to have disadvantage on attacks and ability checks for one turn. Re-occurring.
21–30 (Deranged): You periodically devolve into fits of incoherent babbling, laughing, or crying. During an episode, you have -3 WIS, INT, and CHA. Re-occurring.
31–40 (Obsessed): You become infatuated with another member of your party (chosen randomly), believing they are the most important person in the world, and you will do anything to protect them and/or win their approval, with zero regard for your own safety.
41–50 (Paranoid): You become convinced that another member of your party (chosen randomly) is plotting against you. You cannot provide direct aid to this member, including aiding them on a skill or ability check.
51–60 (Possessed): Your face periodically contorts into a horrifying rictus of insanity. Any character within twenty feet of you that can see you when this happens must make a DC 15 WIS save or take 1D4 psychic damage. If a character succeeds on this save, they are immune to your rictus for one day. Re-occurring.
61–70 (Tormented): The “Thrum of Doom” overtakes you, causing you to become deafened for the duration of this mania. You cannot hear and automatically fail any ability check that requires hearing. You also suffer -3 to Perception.
71–80 (Staggered): You gain a permanent tremor, giving you -5 on all attack rolls, ability checks, and saving throws that require STR or DEX.
81–90 (Inane): Your memory becomes severed, causing you to forget three randomly chosen skills. You cannot make skill checks using those skills for the duration.
91–100 (Feral): You take on an animalistic intensity, giving you +10 feet to your movement and -3 WIS.

Indefinite Mania (Madness): You Gain a Flaw

Duration: Lasts until cured.

01–10 (Alcoholism): You drink heavily to keep your sanity from breaking. Suffer a permanent -1 to DEX, WIS, and CHA until cured. Your habit also costs 1GP per day.
11–20 (Pyromania): You must light at least one object (other than a campfire or torch) on fire twice each day. You also gain an additional +2 attack bonus when using a fire-based weapon or spell.
21–30 (Agromania): You periodically have an overwhelming desire to be alone and out in the open, or you suffer 1D8 psychic damage. Roll 2D20 to determine how many minutes (actual time, not game time) pass before your character experiences another episode. Roll again after each episode.
31–40 (Mythomania): You are a pathological liar and must succeed on a DC 15 WIS saving throw before you can provide a truthful answer or statement. Suffer -2 WIS until cured.
41–50 (Egomania): You become extremely overconfident, bragging often of your prowess, intelligence, and heroic deeds. You must always be first through a door, leading the charge into battle. You must always be the best. Suffer -2 WIS until cured.
51–60 (Logomania): You talk or mutter incessantly, sometimes incoherently or about things that don’t make sense. Suffer -3 CHA until cured.
61–70 (Onomatomania): You become fixated on a specific word (player’s choice) and must use it every time you speak. Suffer -3 CHA until cured.
71–80 (Paranoia): You are convinced that someone or something is trying to harm you, and that you may run into that thing around any corner. Suffer a permanent -1 to WIS and -2 INT until cured.
81–90 (Kleptomania): You become a compulsive thief, stealing small and sometimes larger items whenever given the opportunity. In some cases, you even steal from other members or your party.
91–96 (Narcissism): You are obsessed with your appearance and how others see you, and become angry if people don’t agree with you and admire your deeds and dynamism. You steer every conversation toward yourself or your interests, and interrupt others when they speak too much about themselves. Suffer -3 CHA and -2 WIS until cured.
97–100 (Psychopathy): You completely lack empathy and self control, and act impulsively and without thought of consequences, even if your actions may harm yourself or others. You have a tendency toward antisocial or manipulative behavior. Suffer -5 WIS until cured.

Poise as an Alternative to Exhaustion in D&D