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Nerdarchy > At The Gaming Table  > Character PTSD symptoms in gaming

Character PTSD symptoms in gaming

Open Legend RPG character build - Kryzikk
Skylanders tabletop roleplaying game short campaign (Obsidian Keen)

PTSD in gaming

PTSD symptom

Many Marines return to the states with vivid memories of their combat experiences, and the array of emotions they face internally may be hard to detect. While changes in behavior are more obvious, symptoms can also manifest in physical form. [Marines from Arlington, VA, United States/Wikimedia Commons]

Alrighty, well many a statement has been made about PTSD or Post Traumatic Stress Disorder. Many a facet and corner of the internet is about how to diagnose yourself or whatever, and I only state whatever because that is not what this article is about. What this article is about is how to show and bring this intense aspect of recovery from stress into your game. I bring this up for two sources of inspiration in the last 24 hours. The first being a game session one where one of our players chose the background of soldier, and I was thinking how this is portrayed or roleplayed. The other is that I watched the movie Wonder Woman, in which there is a character that has obvious PTSD or ‘shell shock’ as it was known back then. This all combined to get my mind working for this subject in multiple ways.

What is PTSD?

According to the National Center For PTSD:

“PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.

It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. At first, it may be hard to do normal daily activities, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months.

If it’s been longer than a few months and you’re still having symptoms, you may have PTSD. For some people, PTSD symptoms may start later on, or they may come and go over time.”


PTSD brain. Posttraumatic stress disorder symptoms. [Wikimedia Commons]

That sums it up well, and to state those who have been in life-threatening situations having PTSD more often than those who have not is an understatement. The fact is, we are not made to run at full bore, or balls to the walls as my brother used to say, and come back from it normal. An adventurer’s life or those who come from certain backgrounds, such as soldier, definitely fit the bill to a T.

What effects does the condition have?

Again I will defer to the National Center For PTSD:

“PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD.

There are four types of symptoms of PTSD (en Español), but they may not be exactly the same for everyone. Each person experiences symptoms in their own way.

  1. Reliving the event (also called re-experiencing symptoms). You may have bad memories or nightmares. You even may feel like you’re going through the event again. This is called a flashback.
  2. Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
  3. Having more negative beliefs and feelings. The way you think about yourself and others may change because of the trauma. You may feel guilt or shame. Or, you may not be interested in activities you used to enjoy. You may feel that the world is dangerous and you can’t trust anyone. You might be numb, or find it hard to feel happy.
  4. Feeling keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. You might suddenly get angry or irritable, startle easily, or act in unhealthy ways (like smoking, using drugs and alcohol, or driving recklessly.”

Now this is where it gets intense and will begin coming into play for the player and Dungeon Master. PTSD would likely be the result of many aspects of Dungeons & Dragons. Fighting in wars gone by, being the survivor of an orcish raid, or surviving a dragon attack are all traumatic events. But you should also take the time to consider the effects of running around dungeons, living in the Underdark, or spending other amounts of time in an area that danger could pop up in many forms at any time. The people of your game, NPC and PC alike, don’t often live in a perfectly safe world. They very well may have developed PTSD along the road, which is a great source of roleplay.

How to portray effectively in your game

The effect of PTSD in your game should not always be the super intense flashbacks everyone I’ve gamed with that tried seemed to want to join with. Though it does indeed have those episodes, PTSD can come in many forms and vastly varied intensities. You may have a person who finds themselves with a hyperaddictive personality, drowning themselves in vices. PTSD could come to a dwarven miner who survived a cave-in, his vision distorted and heart racing to vertigo and panic inducing levels at the sheer thought of reentering a tunnel again. The soldier who has seen more death than he could ever care for might be sliding into depression and darker thoughts, his friends and family worried and praying to a god of healing for his recovery.

PTSD character

Dwarf miner. Art by Angus Yi

When you are describing a world in which there has been any event that could have pushed the characters (player or otherwise) to their limits, you should have its effects weighing on the populace, though not every single person would be effected, and not even in the same way. Though you could describe the effects on the populace at large, focusing higher detail on one person is likely to have more of an immersive effect on the players.

A few good ways to do this:

  • Show the fear in the eyes of a refugee. Have them cowering from anyone who resembles their attacker.
  • Have a caravan guard having loud night terrors, waking up in the middle of the night screaming from all that he had to witness.
  • Call/roll for a player to roll versus fear when exposed to something that threatened their life in the past.
  • Describe a character in a location who seems to be preoccupied. If approached let them describe their experience and potentially break down.
  • If the group is off to go explore a location known for giving the area trouble such as a mine full of monsters, a crazed victim of PTSD could desperately try to deter the group from the location.
  • A wizened bartender, potentially an ex adventurer, could break down and weep over those who didn’t survive.


It’s already In Dungeons & Dragons

In fact there is an entire background from the Curse of Strahd adventure dedicated to PTSD and people caring enough to try to help the victim of such. Haunted One is defined by the character having faced a horror that changed their life forever. To quote the background,

Prior to becoming an adventurer, your path in life was defined by one dark moment, one fateful decision, or one tragedy. Now you feel a darkness threatening to consume you, and you fear there may be no hope of escape.”

The Haunted One is a fifth edition D&D character background option from the Curse of Strahd character options.

This event is so intense that the player is dedicated to avoiding it, destroying the source, defending others, or even slowly falling to corruption from it. Haunted One, in any form, is a fairly textbook form of PTSD if you ask me. In fact, it is so eerily similar to someone I know it is frightening. Anyway, remember when I mentioned a caring family? Well the benefit of Haunted One is that in spades.

Heart Of Darkness: “Those who look into your eyes can see that you have faced unimaginable horror and that you are no stranger to darkness. Though they might fear you, commoners will extend you every courtesy and do their utmost to help you. Unless you have shown yourself to be a danger to them, they will even take up arms to fight alongside you, should you find yourself facing an enemy alone.”

Survivor’s guilt

Though not specifically PTSD, I do believe that survivor’s guilt is applicable to this conversation as a form of empathetic PTSD. Survivor’s guilt is defined thusly:

Survivor guilt (or survivor’s guilt; also called survivor syndrome or survivor’s syndrome) is a mental condition that occurs when a person perceives themselves to have done wrong by surviving a traumatic event when others did not.”

Now this may not sound like much, but it can be a real thing. Those who have survived are likely to suffer PTSD-like symptoms, as well as depression based around their feeling that the ones no longer with us are dead due to their actions. They may even punish themselves, or endanger themselves, as a form of penance for simply being the one who survived. This could even be a symptom or form of PTSD that the Haunted One, outlander, sailor, and soldier backgrounds use as a bond. Come to think of it, any of the symptoms of PTSD could be used as traits for your character.

PTSD is a serious subject and I hope that people will not make light of it. Furthermore I sincerely hope that you all will take the time to seek help if you or someone you care for needs help dealing with PTSD. Included here are some resources that you could tap if needed. Because the sources are varied, so to are the resources listed by the PTSD Foundation of America.

Veteran Crisis Line
1.800.273.TALK (8255) – Veterans Press ‘1’

National Veterans Foundation Hotline

Rape, Abuse, and Incest National Network (RAIN) (24 Hours)

National Domestic Violence Hotline

National Council on Alcoholism and Drug Dependence Hope Line

Gulf War Veteran’s Hotline


Those are my thoughts on PTSD in gaming. I am sure there is more cases that could be listed. Like Lord Soth lamenting his failure to save his family. Nonetheless, I hope this can be used to add some depth to your player characters and nonplayer characters through proper display of PTSD. Is there a time your character or someone they ran into displayed PTSD? I would love to hear this in the comments section below.

Play on PS4 or PS3? Did you know that Nerdarchy has a community that plays together often? Go ahead and search in the community section for Nerdarchy and for the player Nubz_The_Zombie!

Did I miss something? Have any Questions or Comments? Feel free to message me at www.facebook.com/NubzTheZombie or at nubz.the.zombie@gmail.com

Stay Nerdy,


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Nigel “Nubz” Sanford

Nubz hails from the American Pacific Northwest where he has spent the last 24 years living the gamer life and running campaigns of all kinds. Through this he has managed to sate his acting bug and entertain many. Now a father, he wishes to pursue writing to leave a legacy in Nerd culture for his offspring to enjoy.


  • Chris
    July 7, 2017 at 5:59 am

    i wish i got to play my Survivors guilt character longer, my party didn’t like how reckless i was with my characters life checking traps, exploring dangerous areas because what did his life matter he was the coward that ran away as the rest of classmates and friends died. poor family sold my character into the military when he was young and opposing country came in and guerrilla style attacked the academy and killed everyone before the training was done

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