PTSD Interaction for Characters

[Matron Mother]

So I run a 3.5 Underdark Campaign, with race both native and foreign to the subterranean realm of Faerun where things can easily cause complications and PTSD with player characters.

I imagine that anything that could trigger a negative sensation/flashback for a character would require a Will Save, the difficulty depending on how many instances the PTSD was triggered, perhaps even in a 3-roll challenge succession to determine the severity of how the PTSD is in terms of vividness (recall memory?).

What I'm concerned about in this campaign, is there are nefarious villains observing, looking for ways to take advantage of the party's flaws as a means to manipulate situations to their disadvantage, leading up to the party possibly failing in a mission, losing a member, and/or coming into direct confrontation with the enemy while being completely vulnerable.

My party is very mature, and has expressed being alright with super negative acts of trauma in a story because they want it to be realistic, but what I want to know is, how do I carefully play on a Character's PTSD without overloading the player mentally with horrific, scarring instances?

[JerichoPenumbra]

I'd say it depends on the trauma involved and how scarred/shaped the character was by it. If it was particularly bad, it might be prudent to have a will save for the PCs to realize that they are having trauma coming to the surface again. I.e. they fail the save and they actually believe they are reliving the experience for the first time. I admit that may be a bit over the top, but it could be used to bring up some kind of event, with the PCs realizing that everything has already happened after the fact. A very dark take on the "all just a dream" scenario. The other way to go about it which may be a bit closer to what you want is going in the opposite direction i.e. instead of some event evoking a very visceral response, it instead evokes disassociation. On the meta-level it provides a means to introduce the event while going lite on the details, due to things not quite clicking mental for the characters. Maybe a modified version of the fascinated condition, with an additional penalty of not being able to benefit from moral bonuses or teamwork/coordination effects while suffering from their episode. They probably also wouldn't be affect by fear effects either.

I'm not sure what else to say. Overall, this seems more dependent on your players mental fortitude.

[Bronk]

My party is very mature, and has expressed being alright with super negative acts of trauma in a story because they want it to be realistic, but what I want to know is, how do I carefully play on a Character's PTSD without overloading the player mentally with horrific, scarring instances?

To not overload the PCs, I think these instances you're talking about have to either be very scarce or able to be worked though. Or both!

A scarce instance could be something that triggers a flaw, something an individual PC would want to roleplay for a long time. Maybe even with a granted feat thrown in.

Something more common might be more like a curse that could be eventually lifted, a missing limb that could be regrown or grafted, a vile spell being dispelled, or the PCs being tortured but then finding someone able to cast 'Heart's Ease'.

[flappeercraft]

I believe there were rules for this or something similar in HoH. If I'm not mistaken it also came with advice on how to do horror campaigns and similar so as how to frighten and there might or might not have been something on how to keep it in check and not go too far.

[Kol Korran]

Some preliminary info: I'm a family doctor, and I also work with quite a few PTSD patients. (I live in Israel. We have our "fair" share). My wife is a psycholigist who also has experience with them, and her brother has PTSD.

You want to play PTSD as realistic? That is... not very feasible... at least not realiatically. While some PTSD patients manage to live a productive and functioning life, they either do it by overcoming their past experience through prolonged exposure methods or similar venues (Basically techniques that enable the patient to return to the traumatic event and relive it with assistance to make it positive. Very hard to do, most can't handle it, and it requires assistance and supervision), or by carefully handling their avoidance and anxiety.

Avoidance of triggers is a huge part of both being a PTSD patient, and functioning as one. You may lessen some avoidances, but for the most part you map out the relevant triggers, remain aware of them and... avoid.

Once flashbacks kicks in, the person deteriorates, and their anxiety, nervousness and either anger/ avoidance patterns kick in... You can't really live normally with this. It disrupts your entir life, and fairly quickly...

Adventurers die at such circumstances. "Realistically" PTSD patient who continue in any activity that triggers their near death/ death experiences (Like 80%+ of adventures?). Die or become a horrible mess...

Most psychiatric illnesses beyond mild conditions are woefully inappropriate for adventurers. I am a hypomanic patient myself, and have worked/ supported/ treated many. You either do the needed therapy (which is HARD!), or you rearrange your life so as to limit exposure and triggers which disrupt you. (Most often both, in varying stages of coping).

Common media (and games as a result) often tries to include some sort of mental illness for characters, but most do it bad, and get a lot of it wrong. They ate horrible to live with, quite hard to overcome (or at least improve), and they nearly never enable high functioning life, unless fairly mild. (And PTSD is by definition a severe illness).

I do not understand trying to roleplay mental illness "realistically", but then again, I have a mental illness myslef. They are not "interesting", "challening" or adding depth. They are crippling, horrific, and dealing with them takes ALL of your energy, not as a "side feature". Realistically, the "adventure" would be fighting to be able to get out of bed in the morning, taking basic steps to take care of yourself, facing the dragons of actually getting out and/ot meeting people. The underdark would be the psychotherapy in which you just try not to get madder and end yourself...

I apologize for going on a tangent. It's jusy that every so often people come up with trying to realistically play adventurers with mental illnesses as if it was "cool", "interesting", "fun", "deep immersive roleplay" or such... I am biased of course, but sometimes I find it insulting... If you truly wish to understand mental illnesses, read about it (Plenty of actual professional literature about it, or "patient experience" stories) or better yet- volunteer/ work in the many organizations which help...

Again, my apologies for the tangent. I know it wasn't exactly what the OP requested, but I think it's important.

[Crake]

I believe there were rules for this or something similar in HoH. If I'm not mistaken it also came with advice on how to do horror campaigns and similar so as how to frighten and there might or might not have been something on how to keep it in check and not go too far.

There are indeed rules for phobias in heros of horror, which can easily be worked into a ptsd-like effect.