Mental Disorder
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Basic Information

A Mental Disorder is a psychological or behavioral pattern which causes distress or disability beyond that expected of normal development or culture.

There is a somewhat blurred line between (allowing for ever changing nomenclature) "mental illness" and "personality disorders", which usually depends on how well integrated the disorder is into the sufferer's identity. In general a personality disorder is better integrated and may not even cause any distress to the "sufferer"1 - these can be difficult to diagnose and still harder to treat (not least because the patient may not be interested in being treated). More conventional mental illnesses are likely to be more obviously dysfunctional and will normally cause the patient distress and/or be noticably disruptive to their baseline personality2.

A disorder may result from psychosocial factors (such as upbringing) or physiological ones (such as defective brain chemistry) or some combination of the two - these can be treated with drugs, social therapies3 or physical therapies4. There is a great deal of debate what works (best) for what.

Historically "madness" was also thought to result from supernatural causes including curses, demonic possession or malign astrological influences. In a supernatural campaign these may or may not exist in parallel to more mundane causes and finding the right tool for the right job will then be even harder. For a real challenge, place someone with a supernatural form of insanity in the care of medical professionals too clever to believe in the supernatural and require the PCs to arrange their cure.

List of Mental Disorders

See Also


2. Mental Health Guru - website has numerous short videos explaining various mental disorders

Game and Story Use

  • Enemies with visible mental disorders can be especially disturbing foes, since the PCs cannot expect them to behave rationally and predictably.
    • In particular, it may not be possible to rely on an insane opponent's sense of self preservation to prevent him from using forms of attack or routes of approach that a sane person would never even consider, or likewise to surrender or run away when it becomes a good idea to do so.
    • Also, someone with a detached view of reality may be capable of atrocities that someone more centred wouldn't contemplate - most mad people are more dangerous to themselves than others, but some can perform horrors without even realising that they are doing wrong.
  • They can also be pitiful, and introduce a note of black and grey morality when the heroes find themselves battling an opponent who is clearly delusional or otherwise not fully in control of his actions.
  • The line between madness and evil can be a thin one - and when they are fighting an enemy who became a monster because of some trauma that his victims inflicted on him in the past, or through being a hero who stared too long into the abyss, then the conflict takes on a very different tone.
  • A mental disorder can also be a quirk for a neutral or allied NPC, or a flaw or hindrance for a PC. This could be anything from compulsions to lost time to a full-on Unreliable Narrator.
  • As stated in the main article, many cultures have attributed mental disorders to supernatural causes. The PCs might need to figure out whether an NPC suffers from schizophrenia or possession… or his claims aren't actually delusional. And then spring him from the mental hospital, save him from the exorcists, or get him away from the wizard who wants to apprentice him.
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