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Curses, diseases, drugs, and poisons can all have effects on
a character that continue long past the character’s first
exposure. This deterioration in physical or mental health is often
represented by what is called a “progression track.” Diseases
and poisons each have default progression tracks whose steps
have specific rules consequences; drugs use the relevant poison
track (for example, drugs that affect Wisdom use the Wisdom
poison track). Some specific afflictions have their own unique
progression tracks defined in their stat blocks. Curses generally
do not use progression tracks—their effects continue until
they’re cured without progressing through stages.
Before an individual is subjected to an affliction, she is considered healthy in terms of the affliction’s progression track, if any. When initially is targeted by an affliction, she must succeed at a saving throw to avoid its effects; if she fails, she is subject to the affliction. If the affliction has a progression track, she is no longer considered healthy with respect to that affliction and immediately gains the effects of the first step on its progression track. For diseases, this is the typically the latent state; at this step, the victim can pass the disease along to others if it’s contagious, but generally suffers no ill effects from it herself. For poisons, the first step on the progression track is usually the weakened step. A truly deadly affliction might cause the victim to start further along a progression track than normal.
Diseases and poisons each have a listed frequency specifying how often a victim must attempt subsequent saving throws to prevent the affliction from progressing. Success could help the victim recover (see Curing an Affliction below); failure means that the victim moves one step further along its progression track, gaining the effects of the next step and keeping all previous effects. A character using a drug must attempt a saving throw each time she uses that drug. Victims typically fail voluntarily, progressing along the drug’s progression track in exchange for benefits, and withdrawal from the drug acts as a disease (see the stat block for Addiction on page 418).
Each progression track has an end state—a point at which the affliction has progressed as far as it can. Once an affliction has reached its end state, the victim keeps all current effects (but doesn’t suffer further effects) and can no longer attempt saving throws to recover from the affliction (see below). By default, diseases, poisons, and drugs have an end state of dead, but some afflictions have less severe end states, while others might have no end state, allowing victims to continue attempting saves.
Some afflictions cause the same effects as a condition (such as sickened; see page 277). Effects that modify, prevent, or remove those conditions do not apply; only effects and immunities against the appropriate affliction apply.
Curing an Affliction: Diseases, drugs, and poisons can be cured if they are treated before the victim reaches the end state. In the case of a disease, the victim must fulfill the conditions in the disease’s Cure entry (usually succeeding at one or more consecutive saving throws). Each time she does so, she moves one step back toward healthy; once she reaches healthy, she is cured. Poisons and drugs work differently—fulfilling the cure condition (or reaching the end of a poison’s duration) removes a poison from the victim’s system, but she remains at the same step on the track and recovers gradually. For every day of bed rest (or two nights of normal rest), a victim moves one step toward healthy. This rate of recovery is doubled by successful Medicine checks (see Long-Term Care on page 143), though tenacious poisons might require a longer recovery period.
Curses can be cured only by fulfilling the unique cure conditions listed in their individual stat blocks or through magic.
Usually, the spell remove affliction (see page 373) immediately cures a victim of an affliction (moving the victim of a disease, drug, or poison to a healthy state on its progression track). However, once a disease or poison has reached its end state, only the most powerful magic or technology (such as miracle or wish, or in the most extreme cases, reincarnate or a regeneration chamber) can remove its effects.
Curses are magical afflictions and usually have a single effect, though some curses use tracks like diseases and poisons do. Removing a curse requires either using remove affliction or fulfilling a special condition that varies by curse (and sometimes differs between individual applications of the same curse).
Diseases are typically inhaled contagions (though these are usually filtered out by a standard space suit or suit of armor) or injury contagions. Page 417 explains the details of each method of contagion. If a disease lacks a Cure entry, its progression may be irreversible without powerful magic or technology, but a successful casting of remove affliction usually prevents further deterioration. Physical and mental diseases have separate tracks.
The victim has contracted a disease. She suffers no ill effects yet, but if the disease is contagious, she can pass it on.
The victim is sickened and fatigued.
The victim is exhausted. Whenever she takes a standard or full action, she must succeed at a Fortitude save at the disease’s DC or lose the action and become nauseated for 1 minute.
Strenuous actions cause the victim pain. If she takes a standard action, she immediately loses 1 Hit Point.
The victim is awake and can converse, but she can’t stand on her own or take any other actions or reactions.
The victim is unconscious and feverish, and can’t be woken.
The victim is dead, and her corpse may still be contagious.
The victim can pass on contagious diseases but suffers no ill effects.
The victim is shaken, and the DCs of his spells and special abilities decrease by 2. He can no longer cast his highest level of spells (if any).
The victim is flat-footed and no longer adds his mental ability score modifiers when calculating number of uses per day of abilities dependent on those scores, including bonus spells per day. The DCs of his spells and special abilities decrease by an additional 2. He can no longer cast his 2 highest levels of spells (if any).
The victim begins losing his grasp on thought, reality, and self. He has a 50% chance each round to take no relevant actions, instead babbling randomly, wandering off, or talking to unseen parties.
The victim is almost entirely disconnected from reality. His mind filters and twists all external stimuli into strange forms. He can no longer tell friend from foe and can’t willingly accept any aid (including healing) from another creature unless he succeeds at a Will save against the disease’s DC.
A victim rendered comatose by a mental disease has lost all grip on reality and entered a dream world. He can’t be woken.
The victim is dead, and his corpse may still be contagious.
Each poison has a delivery mechanism. Page 417 explains the details of the various methods of delivery. A character who is poisoned attempts a saving throw after the listed onset and at the listed frequency thereafter. Upon initial exposure, regardless of whether she succeeds at her saving throw, the victim loses a number of Hit Points equal to the poison’s DC – 10. If a victim is exposed to multiple doses of the same poison, she must attempt a separate save for each dose and progresses to the next state on the poison track with each failed save.
The victim takes a –2 penalty to Strength-based ability checks, attack rolls, damage rolls, and skill checks, and the DCs of his spells and special abilities decrease by 2. The victim’s total carrying capacity is reduced by two-thirds (minimum 1 bulk), and he gains the encumbered condition regardless of how much he is carrying.
The victim takes an additional –2 penalty to the affected checks, rolls, and DCs, and he gains the overburdened condition regardless of how much he is carrying.
The victim is staggered, except he can still take a purely mental full action.
The victim is helpless and can take only purely mental actions.
The victim dies.
The victim takes a –2 penalty to Reflex saves and Dexterity-based ability checks, attack rolls, and skill checks; the DCs of her spells and special abilities decrease by 2; and she becomes flat-footed.
The victim loses her Dexterity bonus to her Armor Class, and she can’t take reactions.
The victim is staggered but can take purely mental full actions.
The victim is helpless and can take only purely mental actions.
The victim dies.
The victim takes a –2 penalty to Fortitude saves, Constitution checks, and Constitution-based DCs. Every time the victim attempts a Fortitude save against the poison—whether he succeeds or fails—he loses Hit Points as per on initial exposure.
The victim takes an additional –2 penalty to the affected checks, and the DCs of his spells and special abilities decrease by 2.
Strenuous actions cause the victim pain. If he takes a standard action, he immediately loses 1 Hit Point.
The victim is unconscious and can’t be woken by any means.
The victim dies.
The victim takes a –2 penalty to all Intelligence-based ability checks and skill checks, and the DCs of her spells and special abilities decrease by 2. If she has 1 or more levels in a spellcasting class whose key ability score is Intelligence, she can’t cast her highest level of spells from that class.
The victim takes an additional –2 penalty to the affected checks and the affected DCs decrease by an additional 2. If she has 1 or more levels in a spellcasting class whose key ability score is Intelligence, she can’t cast her 2 highest levels of spells from that class.
The victim suffers the effects of a feeblemind spell (see page 354), except her Charisma and Charisma-based skills are unaffected.
The victim can’t process thoughts and can’t be woken.
The victim’s brain stops working, and she dies.
The victim takes a –2 penalty to Will saves and Wisdom-based ability checks and skill checks, and the DCs of his spells and special abilities decrease by 2. If he has 1 or more levels in a spellcasting class whose key ability score is Wisdom, he can’t cast his highest level of spells from that class.
The victim takes an additional –2 penalty to the affected checks, and the affected DCs decrease by an additional 2. If he has 1 or more levels in a spellcasting class whose key ability score is Wisdom, he can’t cast his 2 highest levels of spells from that class.
The victim gains the confused condition.
The victim can’t experience reality and can’t be woken.
The victim’s brain stops working, and he dies.
The victim takes a –2 penalty to Charisma-based ability checks and skill checks, and the DCs of her spells and special abilities decrease by 2. If she has 1 or more levels in a spellcasting class whose key ability score is Charisma, she can’t cast her highest level of spells from that class.
The victim takes an additional –2 penalty to the affected checks and DCs. If she has 1 or more levels in a spellcasting class whose key ability score is Charisma, she can’t cast her 2 highest levels of spells from that class.
The victim has little sense of self and goes along with nearly any order or suggestion. Creatures attempting Bluff, Diplomacy, or Intimidate checks against her automatically succeed, though Diplomacy checks to improve her attitude still have the normal DC.
The victim loses agency and can’t interact with anything.
The victim loses autonomic functions and dies.
Drugs are a special kind of poison that grant a beneficial effect right away but also move the user a single step down the associated poison track. However, the user doesn’t lose Hit Points, even if the drug functions as a Constitution poison. Taking a drug also exposes the user to the addiction disease (see page 418), with a DC that depends on how addictive the drug is. If a character is dosed with a drug against his will, he can attempt a Fortitude save against the drug’s DC. If he succeeds, this negates both the drug’s beneficial and negative effects, as well the chance for addiction. Immunity to poison or a similar effect prevents a character from experiencing the drug’s beneficial effects, and removing or suppressing a drug’s negative effects with restorative spells also cancels the benefits.
The following section includes a number of sample afflictions.
Listed effects stack with the standard effects for the listed track,
unless the effect specifies a different track, in which case it
supersedes the regular track. If a disease or poison doesn’t specify
an effect, it imposes the standard effects for the listed track.
The individual lines of information in affliction stat blocks are described below. Those marked “Optional” appear only if relevant.
Name: This lists the name of the affliction.
Type: This shows the type of the affliction, such as a curse, disease, drug, or poison. Where applicable, this line also states in parentheses the means by which it is contracted, such as contact, ingestion, inhalation, or injury. Afflictions that have multiple methods of contraction indicate this here.
A contact affliction is delivered by any contact with bare skin, which generally requires an attack against EAC if the intended target is unwilling. A contact affliction can also be injected like an injury affliction. Contact afflictions often take 1 minute or longer to take effect.
An ingested affliction is delivered by tricking the intended target into eating or drinking it. Ingested afflictions often take 10 minutes or longer to take effect.
An inhaled affliction is delivered the moment a creature that breathes (and isn’t wearing a space suit or suit of armor that filters out such toxins) enters an area containing such an affliction. Most inhaled afflictions fill a volume equal to a 10- foot cube per dose. A creature at risk can attempt to hold its breath while inside such an area to avoid inhaling the affliction. There is a 50% chance each round a creature holding its breath doesn’t need to attempt a saving throw against the affliction (see Suffocation and Drowning on page 404).
An injury affliction is delivered through damage to the target, usually via a slashing or piercing kinetic attack dosed with the affliction. These afflictions often take effect immediately.
Save: This indicates the type of saving throw necessary to avoid contracting the affliction, as well as its DC. Unless otherwise noted, this is also the saving throw to avoid the affliction’s effects once it is contracted.
Addiction (Optional): Typically only applicable to drugs, this line lists the saving throw type and DC to avoid addiction. See page 418 in Diseases for more about how addiction works.
Track: This line indicates the progression track used once a character is affected by the affliction.
Onset (Optional): Some afflictions have a variable amount of time before they set in. Creatures that come into contact with an affliction with an onset time must attempt a saving throw immediately, and if they fail, they suffer the appropriate effect after the onset time has passed. The creature then must continue to attempt saving throws against the affliction’s effects as normal.
Frequency: This is how often the periodic saving throw must be attempted after the affliction has been contracted. If the affliction lists an amount of time after its frequency—such as 1/minute for 6 minutes—that means its effects last for only that amount of time, regardless of whether the affected creature ever succeeds at a saving throw. Such an affliction cannot be cured via successful saving throws; after its duration ends, the victim remains at her current step on its progression track until she receives the benefit of remove affliction or a similar effect.
Effect (Optional): This line lists the affliction’s special effects, if any, beyond the effects of its appropriate progression track.
Cure (Optional): This indicates how the affliction is cured. Usually, this is number of consecutive, successful saving throws. Even if an affliction has a limited frequency, it might be cured earlier if the affected creatures succeeds at enough saving throws. Afflictions without a cure entry can be cured only through spells such as remove affliction.