Derangements are behaviors that are created when the mind is forced to confront intolerable or conflicting feelings, such as overwhelming terror or profound guilt. When the mind is faced with impressions or emotions that it cannot reconcile, it attempts to ease the inner conflict by stimulating behavior such as megalomania, bulimia or hysteria to provide an outlet for the tension and stress that the conflict generates.

Characters receive derangements under conditions of intense terror, guilt or anxiety. If a player botches a Virtue or Willpower roll (for example, when confronted with Rotschreck) the Storyteller may decide that the experience causes a derangement in the character. Other examples of derangement-incuding events include killing a loved one while in a frenzy, being buried alive, or seeing hundreds of years of careful scheming dashed in an instense and unpleasant emotion or thoroughly violates a character's beliefs or ethics is severe enough to cause a derangement. The Storyteller alone determines which derangement a character receives, choosing (or creating) one appropriate to the character's personality and the circumstances of the event that caused the disorder.

It must be noted that people who are "crazy" are neither funny nor arbitrary in their actions. Insanity is frightening to those who are watching someone rage against unseen presences or hoard rotten meat to feed the monsters that live next door; even something as harmless-sounding as takling to an invisible rabbit can become disturbing to onlookers. The insane, however, are only responding to a pattern known to them, stimuli that they perceive in their own minds. To their skewed perceptions, what's happening to them is perfectly normal — to them. Your character's derangement is there for a reason, whether he's a Malkavian who resided at Bedlam before his Embrace or a Ventrue who escaped from five months of torture at the hands of an Inquisitor. What stimuli is his insanity inflicting on him, and how is he reacting to what's happening? The player should work with his Storyteller to create a pattern of provocations for his derangement, and then decide how his character reacts to such provocation.

Derangements are a challenge to roleplay, without question, but a little time and care can result in an experience that is dramatic for all involved.

Acute Sanguinary Aversion

This derangement, unique to the undead, involves a persistent fear that any source of vitae is dangerous. Explainations vary - some vampires fear drugged or contaminated blood, the wrath of God or the presence of a blood-borne Antediluvian. Regardless, unless the vampire is frenzied, the player must succeed on a Willpower roll (diff 8) each time he feeds. Willpower cannot be spent on this roll, and a botch indicates that the vampire is so revolted by the prospect of feeding that he vomits up half his blood pool.

Acute sanguinary aversion usually leads to a starve-and-frenzy pattern, with the vampire avoiding feeding until he loses control. Instead, the vampire might develop highly ritualized feeding methods that involve obsession with repeated, largely arbitrary behaviors that must be observed before the Kiss is performed on a particular source of vitae. He might read a passage from the Book of Nod before feeding or drink blood only from a particular individual.

In any case, if the feeding results in a Conscience or Conviction roll, increase the difficulty by one.


Agoraphobia literally means "fear of open spaces," but the translation is misleading. Called "Mad Scientist's Disease" by younger neonates, agoraphobia manifests as an extreme aversion to places the sufferer fears he will panic. Sometimes the derangement is attached to a few locations, but generalized agoraphobics avoid situations in which escape is difficult (an airplane at 30,000 feet) or embarassing (making a speech).

Agoraphobics don't volunteer for situations that they fear might cause anxiety. Unless supernaturally compelled, agoraphobic vampires must succeed on a Willpower roll (difficulty 8) to leave their havens each evening and must spend a point of Willpower to enter a situation from which escape will be difficult or embarassing. If the character fails any Willpower roll during a scene that takes place in such a situation, the character must spend ap oint of Willpower or flee immediately. Vampires can ignore these constraints only while in frenzy.

The territorial nature of many Cainites makes this derangement relatively common. No doubt the world is scattered with at least a handful of agoraphobic Cainites driven into torpor from a lack of blood.


Individuals with bulimia assuage their guilt and insecurity by indulging in activities that comfort them - in this case, consuming food. A bulimic will eat tremendous amounts of food when subjected to stress, then empty her stomach through drastic measures so she can eat still more. In the case of vampires with this derangement, the need to feed is a means of relieving the fear and anxiety endemic to the World of Darkness. A bulimic vampire may feed four or more times a night - gorging herself, burning the blood in pointless (or not so pointless) activity, then starting the cycle again.

Vampires: A vampire with bulimia gets hungry much more quickly than other vampires do. When feeding, a bulimic vampire must make a Conscience roll (difficulty 7). If she fails the roll, she feeds until her blood pool is full, whether the vampire needs the extra blood or not. A vampire who is forcibly kept from feeding risks frenzy (make a frenzy roll, difficulty 6). The difficulty increases by one for every 15 minutes that she is prevented from drinking.


Victims suffering from fugue experience "blackouts" and loss of memory. When subjected to stress (not general stress, but stress invariably related to the incident which caused the derangement), the individual begins a specific, rigid set of behaviors to remove the stressful symptoms. This differs from multiple personalities, as the individual in the grip of a fugue has no separate personality, but is on a form of "autopilot" similar to sleepwalking.

Characters suffering from this derangement require a Willpower roll when subjected to extreme stress or pressure (difficulty 8). If the roll fails, the player must roleplay her character's trancelike state; otherwise, control of the character passes to the Storyteller for a number of scenes equal to the roll of a die. During this period, the Storyteller may have the character act as she sees fit to remove the source of the stress. At the end of the fugue, the character "regains consciousness" with no memory of her actions.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is much more than the normal anxiety people experience day to day. It's chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.

People with GAD can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. People with GAD also seem unable to relax. They often have trouble falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheaded or out of breath. They may feel nauseated or have to go to the bathroom frequently. Or they might feel as though they have a lump in the throat.

Many individuals with GAD startle more easily than other people. They tend to feel tired, have trouble concentrating, and sometimes suffer depression, too.

Usually the impairment associated with GAD is mild and people with the disorder don't feel too restricted in social settings or on the job. Unlike many other anxiety disorders, people with GAD don't characteristically avoid certain situations as a result of their disorder. However, if severe, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities.

GAD comes on gradually and most often hits people in childhood or adolescence, but can begin in adulthood, too. It's more common in women than in men and often occurs in relatives of affected persons. It's diagnosed when someone spends at least 6 months worried excessively about a number of everyday problems.

Gender Identity Disorder

A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex).

The disturbance is manifested by symptoms such as:

  • a stated desire to be the other sex
  • frequent passing as the other sex
  • desire to live or be treated as the other sex
  • or the conviction that he or she has the typical feelings and reactions of the other sex
  • persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex · preoccupation with getting rid of primary and secondary sex characteristics ( e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.


Some ghouls sublimate their urge to escape or believe that their new powers entitle them to a certain amount of attention. Ghouls who develop histrionics must be center stage in all situations. They affect extreme but shallow emotions or behave and dress provocatively. Each scene, a histrionic ghoul must spend a point of Willpower to avoid seeking the spotlight in some way. If his quest for recognition is unsuccessful, he cannot spend Willpower; raise his difficulty to avoid frenzy by three for the rest of the scene.

Vampires develop this derangement as well. A childe might subconsciously rebel against the indifference of a sire. An old Cainite who lacks the status implied by his age might become obsessed with being noticed. A Nosferatu might overcompensate for his hideous appearance or even for spending too much time Obfuscated.

Players beware: This derangement isn’t a license to hog every scene, then write it off as roleplaying. Histrionics are hypersensitive to the opinions of others, not oblivious to the glares of the crowd as they enact some slapstick melodrama. Histrionic cases are pathetic, and most people recognize them as such the first time they flash their shit-eating grins or refuse to leave the stage. A histrionic might latch onto one person the entire evening and pester her for every ounce of attention. He might become sullen or leave in a huff if he believes that someone has upstaged him. If your Storyteller allows this derangement, roleplay it as the emotion disorder it is rather than an excuse to be obnoxious.


A person in the grip of hysteria is unable to control her emotions, suffering severe mood swings and violent fits when subjected to stress or anxiety. For many characters in the World of Darkness, that can be all the time. Decide on a particular circumstance that triggers your character's episode: the presence of children, contact by your Sire or, as a Hunter, the Heralds, or perhaps an open flame.

Vampires: Hysterical Kindred must make frenzy checks whenever subjected to stress or pressure. The difficulties of these rolls are normally 6, increasing to 8 if the stress is sudden or especially severe. Additionally, any action that results in a botch causes the vampire to frenzy automatically.

Hunters: You must make a Willpower roll whenever your character is subjected to this brand of stress or pressure. The difficulty of the roll is usually 6, increasing to 8 if the stress is sudden or especially severe.


You have recoiled from the horror of your situation and protect yourself by feeling nothing. You insulate yourself in a world of logic and intellectual vigor where emotions have no place. By isolating your incompatible needs and thoughts into separate compartments you avoid losing control. However, the pressure inevitably mounts and the dam eventually bursts. If you passion and emotion are thrust upon you during a stressful situation, you may frenzy. This frenzy may last for some time depending on how long it's been since you last "let off steam" (Ask your Storyteller).


Manic-depressives suffer from severe mood swings, sometimes resulting from severe trauma or anxiety. Victims may be upbeat and confident one moment, then uncontrollably lethargic and pessimistic the next. Characters with this derangement are constantly on a hair trigger, never knowing when the next mood swing will strike. Whenever the character fails a task, the Storyteller has the option of secretly making a Willpower roll (difficulty 8) for her. If the character fails the roll, she lapses into depression. Additionally, the character will go into depression whenever one other rolls is botched, or, as a vampire, if her blood pool ever drops below 2. The Storyteller should roll a die to determine how many scenes the character remains depressed, keeping the number a secret.

Vampires: Vampires in a depressive state have their Willpower ratings halved (minimum 1). In addition, the vampire may not access her blood pool to raise Attributes. Upon emerging from the depressive state, the character is energetic, relentlessly upbeat and active (obsessively so) for a number of scenes proportionate to the time spent in depression. When a vampire is in this manic state, the difficulty of all rolls to resist frenzy is raised by one.

Hunters: A Hunter in a depressive state loses a point of Conviction (to a minimum of 1) for the duration of the mental episode. Upon emerging from the depressive state, the character is energetic, relentlessly upbeat and active (obsessively so) for a number of scenes proportionate to the time spent in depression. When your character is in a manic state, the difficulty of all Willpower rolls is reduced by one.


Individuals with this derangement are obsessed with accumulating power and wealth, salving their insecurities by becoming the most potent individuals in their environment. Such individuals are invariably arrogant and supremely sure of their abilities, convinced of their own inherent superiority. The means of achieving their status can take many forms, from devious conspiracies to outright brutality. Any individual of equal or higher status than the victim is perceived to be "competition."

Characters with this derangement constantly struggle to rise to the height of power and influence, by whatever means
necessary. In a megalomaniac's view, there are only two classes of people: those who are weaker, and those who do not deserve the power they have and must be made weaker. This belief extends to everyone around the character, including members of her own coterie. This derangement lends an extra die to all of the victim's Willpower rolls, due to her towering sense of superiority.

Vampire: If a megalomaniacal vampire is presented with the chance to diablerize a more potent Kindred, she will be sorely tempted. A Willpower roll (difficulty 10) is needed for the vampire to avoid taking "what is rightfully hers."

Hunters: Hunters with this derangement struggle constantly to rise to the height of power and influence, by any means necessary, whether against monsters, fellow hunters or the defenseless. In a megalomaniac's view, there are only two classes of people: those who are weaker, and those who do not deserve the power they have, and so must be made weaker. This belief extends to everyone, including your character's immediate allies. This derangement lends an extra die to all of the victim's Willpower rolls, due to her towering sense of superiority.

Multiple Personalities

The trauma that spawns this derangement fractures the victim's personality into one or more additional personas, allowing the victim to deny her trauma or any actions the trauma causes by placing the blame on "someone else." Each personality is created to respond to certain emotional stimuli - an abused person might develop a tough-as-nails survivor personality, create a "protector," or even become a murderer in order to deny the abuse she is suffering. In most cases none of the personalities is aware of the others, and they come and go through the victim's mind in response to specific situations or conditions.

When a character suffers this derangement, the Storyteller and the player must agree upon how many and what kind of personalities develop, and the situations that trigger their dominance in the victim. Each personality should be relevant to the trauma that causes it. Not only is each personality distinct, but in the case of Kindred, the different personalities might believe themselves to be from different clans and sires.

Characters with multiple personalities can manifest different Abilities and even Virtues for each of their personalities, but it is the Storyteller's responsibility to determine the specific details.

Obsessive Compulsive Disorder

The trauma, guilt or inner conflict that causes this derangement forces your character to focus nearly all of his attention and energy on a single repetitive behavior or action. Obsession relates to an individual's desire to control his environment — keeping clean, keeping an area quiet and peaceful, or keeping undesirable individuals from a place. A compulsion is an action or set of actions that an individual is driven to perform to soothe his anxieties: placing objects in an exact order, constantly checking to make sure a weapon is loaded, praying every few hours to give thanks for surviving that long.

Mortal: If your character has an obsessive or compulsive derangement, determine a set of specific actions or behaviors, as described above. Your character follows them to the exclusion or all else, even if they interfere with the mission or endanger his life or others' lives. The effects of obsessive/compulsive behavior can be negated for the course of one scene by spending a temporary Willpower point. If a hunter is forcibly prevented from adhering to his derangement, he may lose control amongst enemies or allies and attack either (or both) indiscriminately.

Vampires: Vampires with an obsessive or compulsive derangement must determine a set of specific actions or behaviors, as described above, and follow them to the exclusion of all else. The effects of obsessive/compulsive behavior can be negated for the course of one scene by spending a temporary Willpower point. The difficulty of any attempt to coerce or Dominate a vampire into ceasing her behavior is raised by one. If a vampire is forcibly prevented from adhering to her derangement, she automatically frenzies.

Panic Disorder

People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They can't predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike. In between times there is a persistent, lingering worry that another attack could come any minute.

When a panic attack strikes, most likely your heart pounds and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control. You may genuinely believe you're having a heart attack or stroke, losing your mind, or on the verge of death. Attacks can occur any time, even during nondream sleep. While most attacks average a couple of minutes, occasionally they can go on for up to 10 minutes. In rare cases, they may last an hour or more. Panic disorder strikes between 3 and 6 million Americans, and is twice as common in women as in men. It can appear at any age - in children or in the elderly - but most often it begins in young adults. Not everyone who experiences panic attacks will develop panic disorder - for example, many people have one attack but never have another. For those who do have panic disorder, though, it's important to seek treatment. Untreated, the disorder can become very disabling.

Panic disorder is often accompanied by other conditions such as depression or alcoholism, and may spawn phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you're riding an elevator, you may develop a fear of elevators and perhaps start avoiding them.

Some people's lives become greatly restricted - they avoid normal, everyday activities such as grocery shopping, driving, or in some cases even leaving the house. Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person. Basically, they avoid any situation they fear would make them feel helpless if a panic attack occurs. When people's lives become so restricted by the disorder, as happens in about one-third of all people with panic disorder, the condition is called agoraphobia. A tendency toward panic disorder and agoraphobia runs in families. Nevertheless, early treatment of panic disorder can often stop the progression to agoraphobia.


The victim of paranoia believes that her misery and insecurity stem from external persecution and hostility. Paranoids obsess about their persecution complexes, often creating vast and intricate conspiracy theories to explain who is tormenting them and why. Anyone or anything perceived to be "one of them" is often subjected to violence.

Kindred who suffer from paranoia have difficulty with social interaction; the difficulties of all dice rolls involving interaction are increased by one. They are distrustful and suspicious of everyone, even their own blood bound progeny. The slightest hint of suspicious behavior is enough to provoke a frenzy roll, with the difficulty relative to the degree of the behavior. This paranoia may even extend to complex and rigorous feeding practices, to keep "them" from contaminating the vampire's food supply.


When things go wrong and nothing seems to be going right, you can become obsessed with perfection. Everything must be perfect, and you use all your energy to prevent anything from going wrong. All your energy and attention is focused on keeping everything about you in perfect, unaltered condition. When things become hopelessly confused, fault-ridden and messy, you may enter into a frenzy.


Some ideas… some of these are just silly.
Ablutophobia - Fear of washing or bathing
Acarophobia - Fear of itching or of the insects that cause itching
Achluophobia - Fear of darkness.
Acrophobia - Fear of heights
Agrizoophobia - Fear of wild animals
Alliumphobia - Fear of garlic.
Androphobia - Fear of men
Aphenphosmphobia - Fear of being touched
Autophobia - Fear of being alone or of oneself.
Catagelophobia - Fear of being ridiculed
Catoptrophobia - Fear of mirrors.
Dementophobia - Fear of insanity
Eleutherophobia - Fear of freedom.
Erotophobia - Fear of sexual love or sexual questions.
Gynephobia or Gynophobia - Fear of women
Kathisophobia - Fear of sitting down.
Ligyrophobia - Fear of loud noises.
Melanophobia - Fear of the color black.
Nudophobia - Fear of nudity.
Nyctohylophobia - Fear of dark wooded areas, of forests at night
Photophobia - Fear of light.
Poinephobia - Fear of punishment.
Potamophobia - Fear of rivers or running water.
Pyrophobia - Fear of fire.
Rupophobia - Fear of dirt.
Sciophobia/Sciaphobia - Fear of shadows.
Selenophobia - Fear of the moon.
Sexophobia - Fear of the opposite sex. (Heterophobia)
Teleophobia - 1) Fear of definate plans. 2) Religious ceremony.
Xylophobia - 1) Fear of wooden objects. 2) Forests.
Atychiphobia - Fear of failure.
Chromophobia or Chromatophobia - Fear of colors.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) arises in response to severe trauma such as combat, rape or servitude to a Tzimisce. A ghoul who has been the subject of his master’s latest experiment with superdermal bone art or witnessed his hungry master devour his mortal family might develop this derangement. PTSD can even afflict vampires, perhaps those who survived a Lupine attack or awoke one night to find their havens on fire.

Symptoms manifest as recurrent, debilitating flashbacks and extreme avoidance of situations likely to recreate the initial trauma. The player of a ghoul or Cainite afflicted with PTSD must spend a point of Willpower for her character to enter such situations. If compelled by a blood bond or other forms of control, the sufferer’s player cannot spend Willpower to gain automatic successes on any rolls, and all of the character’s dice pools are halved (round down). In any circumstances, botched Willpower rolls or other stimuli deemed appropriate by the Storyteller induce flashbacks of the traumatic episode with the same penalties described above. Ghouls laboring under this disorder are typically disposed of by their domitors. Clan Tzimisce requires servants made of sterner stuff.

Power Object Fixation

The vampire afflicted with this derangement has invested much of his self-confidence in an external object, to the point where she believes she cannot function properly without its presence. Such a derangement is often linked to some past trauma in which the object in question played a major role - although not always in the obvious way. For instance, the victim might fixate on his dead fiancée's engagement ring if holding his fiancée's hand was his only comfort during hard years, but another individual might focus on the belt his father beat him with as a sorce of strength.

Victims of fixation lose two dice from all their dice pools if somehow seperated from their object of focus. It is hard to hide such a fixation from careful observers, in times of stress, the vampire must make a willpower roll to avoid cradling the object to her torso, rubbing it obsessively or otherwise physically comforting herself with its presence.

This derangement sometimes spawns other related derangements over time. The fixated person may, for instance, develop multiple personalities related to the object - the aforementioned abuse victim might spawn a bullying personality much like her abusive father, and so on.

Sanguinary Animism

This derangement is unique to the Kindred, a response to vampires' deep-seated guilt regarding the act of feeding on the blood of mortals. Kindred with this derangement believe that they do not merely consume victims' blood, but their souls as well, which are then made a part of the vampire's consciousness. In the hours after feeding, the vampire hears the voice of her victim inside her head and feels a tirade of "memories" from the victim's mind - all created by the vampire's subconscious. In extreme cases, this sense of possession can drive a Kindred to carry out actions on behalf other victims. Obviously, diablerie would be unwise for an animist to perform….

Whenever a vampire with this derangement feeds on a mortal, a Willpower roll is needed (difficulty 6, or 9 if she drains the mortal to the point of death). If the roll succeeds, she is tormented by the "memories" of the person whose soul she has partially consumed, but is still able to function normally. If the roll fails, then the images in her mind are so strong that it is akin to having a second personality inside her, an angry and reproachful personality that seeks to cause harm to the vampire and her associates. The player must roleplay this state; otherwise, control of the character passes to the Storyteller, who runs the character as if the mind other victim is in control. During the moments just before dawn, control automatically reverts to the vampire.

Sexual Dysfunction

A ghoul who spends any time in the thrall of a Tzimisce domitor is likely encumbered with a variety of sexual dysfunctions. Female ghouls typically develop vaginismus, involuntary contracting of the vulval and rectal muscles preventing penetration, or dyspareunia, severe pain during intercourse. Males, if not rendered completely impotent, sometimes fixate sexually on acts favored by their domitors. All such conditions are likely to instill an extreme aversion to sex, further separating ghouls from the lifestyles they lead prior to their servitorship.

Before allowing this derangement, Storytellers should consider whether its inclusion will make any players uncomfortable. Many people prefer not to explore such personal issues in detail, especially during a game. Although the setting is a suitable venue for such unpleasantness, you can challenge your players without resorting to poor taste. These caveats in mind, this derangement can be played without mentioning graphic details – Storytellers can extrapolate the likely effects such a condition might have on a ghoul’s relationship with his or her partners.


Conflicting, unresolveable sets of feelings and impulses can cause a victim to develop schizophrenia, which manifests as a withdrawal from reality, violent changes in behavior, and hallucinations. This is the classical sort of derangement, causing victims to talk to walls, imagine themselves to be the King of Siam, or receive instructions from their pets telling them to murder people.
Roleplaying this derangement requires careful thought, because the player must determine a general set of behaviors relevant to the trauma that caused the derangement. The hallucinations, bizarre behavior and unseen voices stem from a terrible inner conflict that the individual cannot resolve. The player needs to establish a firm idea of what that conflict is and then rationalize what kind of behavior this conflict will cause.

Kindred with this derangement are unpredictable and dangerous. In situations that trigger a vampire's inner conflict, the difficulties of all rolls to resist frenzy increase by three, and the vampire loses three dice from all Willpower rolls.