How Do I Use Sanity in My D&D 5e Game?

It’s the Halloween season, which makes it a great time to talk about one a variant rule from D&D 5e: Sanity. 

What is sanity? 

Reality is the standard for our characters, whatever that is. Take my favorite setting, Eberron. The gods may or may not be real; the demons are a thing of the ancient past and most people think they’re legends; the daelkyr (the cthulus of the world) are locked away and believed to be entirely myths. Magic is common to the people of Eberron, so uses of it likely wouldn’t boggle the mind — though perhaps the highest levels would shock and awe (as most characters don’t learn spells about level 3). 

Sanity is a way to measure how your characters in your campaign deal with these times which deviate so heavily with reality: a demon or angel shows up, a literal voice of a deity or Overlord demon whispers in their ear, they tumble into an area affected by a cult which alters reality, etc. 

Why should I have sanity in my campaign?

I’ll be honest, I often add the stat, but it’s rarely used — as it should be! Most of a character’s existence is going to fall into some level of “normal.” This can vary drastically between characters. To use a Lord of the Rings analogy: what would drive Frodo, Aragorn, Gimli, Legolas, and Gandalf to make sanity checks would be drastically different. 

If you’ve already started a campaign, it’s not difficult to add in. You can have them roll a new stat, or you can use my alternate method of using 10+WIS mod + INT mod (because I like it as a derivative stat). 

But this is why I like to have it: the higher your characters go, the less HP loss affects them. Sanity, seeing their character lost to the void because they’ve come across something beyond them, is something to fear akin to their becoming a werewolf. 

Sanity is something you don’t really have to check in on after you set it, except for when you need it. It definitely works best if your game has some horror elements or a game with some grit.

When should I use sanity? 

I only have two events which cause me to have a character roll a sanity check: 

  1. The character or characters have come across a tremendous supernatural power which affects them negatively. 
  2. The character or characters experience a terrible loss, such as the death of an ally. 
Photo by Harry Cunningham on

What happens when a character succeeds a sanity check?

This check means that the character is able to incorporate the event into reality. They may still be afraid or horrified, but they are capable of dealing with the situation however they want. 

However, sanity checks are rarely one and done, just like the amazing feats of heroics in a typical game. 

What happens when a character fails a sanity check?

This is usually where the fun begins. I have characters deduct their sanity by one point and use that number to determine what level of insanity they earn. They are inflicted with either a random insanity from the DMG tables or a chosen one to fit the current situation. 

Can characters regain sanity?

If a character experiences insanity, most cases are temporary and not necessarily debilitating. Most are best treated with, like a physical injury, some long resting and/or some magic. 

Photo by cottonbro on

At my table, since I have the house rule about losing a point when failing sanity checks, I also created a house rule where if they choose to rest for a week (think a long rest vacation), they can regain a point of lost sanity. I also have characters gain 1 point of sanity at levels 5, 11, and 17 (as they progress through the tiers of play). I could also see a cleric or paladin going about their work in a temple with the same effect as a vacation as they deal with their experience through their faith; a character doing research could find a similar result as they try to learn about what is outside their reality to incorporate it into a new reality. 

If you’re interested in seeing more on how I use this system, check out my pay-what-you-want supplement from the dungeon master’s guild!

Thank you for reading! If you found it helpful or interesting, give this post a like a subscribe to this blog. Hope you have a happy Halloween!

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