On Madness

Here is my take on the insanity rules. I took inspiration from these posts, so I should give credit where credit's due.

From Darkest Dungeon.

Trauma is gained when you loose limbs, friends, or see what no human should. You might gain more than 1 point at once, depending on the circumstances. Every time you gain any Trauma, roll under [Will  - Trauma] or Crack. Critical failure, gaining Trauma equal to Will, or gaining enough Trauma that your Memory overflows (see below) causes permanent Insanity and resets Trauma back to 0. Rolling exactly the target number instead grants you a random Virtue. Each point of Trauma also fills a Memory slot. Insanity does not go to your Memory, and instead is treated as an injury.

A nightly rest may reduce Trauma by 1 if you get drunk, high, laid, or otherwise relieve stress. A week of recuperation in town removes 1d6+WIL Trauma. Insanity cannot be removed by any normal means, but can be alleviated by various potions and therapies.

The Hunger, the Madness, the Crime

d8 Cracks

1. Abusive: Why aren't they pulling their weight? For 1d6 rounds when an ally fails an action, they take 1 Trauma as you scream obscenities at them.
2. Blackout: You faint for 1d6 rounds. You can be slapped awake.
3. Breakdown: You cannot see for tears, nor speak for sudden stutter. Lasts 1d6 rounds.
4. Fight-or-Flight: For 1d6 rounds, you either viciously attack the source of Trauma, or run away. Your choice.
5. Hopeless: All is lost. Your despair makes all allies roll with disadvantage for the next round.
6. Nausea: You gag or vomit for a round, and cannot benefit from Lunch today.
7. Scream: Aaaaaaaaaaaaaaaa!!!!!!! If anyone didn't know you are here, they will now. May provoke a Random Encounter.
8. Shock: What's happening? Save once per round, until you succeed you can take no actions.

d8 Virtues

1. Confidence: You will prevail. You deal +1 damage until the end of encounter.
2. Courage: There is nothing to fear but fear itself. You are immune to fear and Trauma until the end of encounter.
3. Focused: Suddenly, a moment of inner peace. You have advantage on your next roll.
4. Inspiring: Your unwavering resolve emboldens your allies. They may all roll a new Save against one of their current afflictions.
5. Invincible: You must persevere. You postpone all injuries and madness until the end of encounter.
6. Selfless: You are all in this together. You may redirect an attack from an ally to yourself until the end of encounter.
7. Stalwart: None shall pass. You cannot be moved, knocked prone or tripped until the end of encounter.
8. Vigorous: You feel more alive than ever before. Heal 1d6 hp.

Insanity by kiki71

d20 Insanities

1. Addiction: You need your fix to get through the day. If you don't get your drug, you automatically Crack every time you gain Trauma, in addition to any withdrawal effects.
2. Amnesia: Roll d20 on your Memory and loose whatever is in the slot you rolled. If you roll an empty slot, that slot is permanently filled with Brain Damage.
3. Anxiety: Your are a nervous wreck. You take -4 on Saves vs Fear and all fear effects have double duration for you.
4. Catatonic: You are completely unresponsive until you can be brought back to town and nursed back to your senses over an extended rest.
5. Delusion: Roll d6: 1) You are the long-lost heir of the throne. 2) You can fly*. 3) You will burn in sunlight. 4) You are of a different race / an animal. 5) You are invincible. 6) All magic is inherently bad. You cannot be convinced otherwise and rationalise any evidence as an illusion, trick, or any barely believable "explanation".
6. Depression: Every day is a struggle. Roll with disadvantage until the first time you succeed on a roll in a given day.
7. Hallucinations: The GM might sometimes describe something incorrectly or in a misleading way to you.
8. Insight: When encountering a thing beyond human comprehension, you have a 50% chance of gaining a useful piece of information, and a 50% chance of trying to claw your eyes out, taking 1d6 damage and blinding yourself for 1d6 rounds.
9. Minor Compulsion: Once per day when the GM calls for it, you must stop everything else to satisfy your compulsion (wash your hands, count your money, vandalise something). Good roleplaying of the compulsion should prevent the GM from using this at too troublesome times.
10. Major Compulsion: Once per week when the GM calls for it, you must stop everything else to satisfy your compulsion (kleptomania, necrophilia, cannibalism). Good roleplaying of the compulsion should prevent the GM from using this at too troublesome times.
11. Nightmares: Save each night or wake up screaming, gaining only half the effects of rest. Alcohol or opiates may grant you serene sleep.
12. Obsession: You become obsessed with a random person and start following them around. You "love" them. If you don't see them for a day, you automatically Crack every time you gain Trauma.
13. Paranoia: No one counts as an ally to you. You must Save to accept aid or work in a team.
14. Phobia: You have a phobia based on what caused this insanity (or roll a random one if this does not make sense). Gain 1 Trauma when you encounter something that triggers your phobia.
15. Quirks: You have personality quirks. Severe ones. Roll d8: You 1) talk to yourself, 2) laugh wildly and inappropriately, 3) constantly fidget, 4) eat odd substances, 5) mimic those around you, 6) have irritating tics, 7) stutter, 8) suffer tremors. You take a penalty to Reaction rolls and social checks equal to current Trauma.
16. Sadism: You are brutal and violent. Every time you kill a creature, everyone in sight takes 1 Trauma as you revel in the suffering.
17. Schizophrenia: Make a new character sheet with a different class, but the same name, race, attributes etc. Each session, alternate between these two character sheets.
18. Self-Mutilation: Every time you would take Trauma, you can instead take 1d6 damage. If you take no damage for a whole day, you must hurt yourself for 1d6 damage. You are covered in scars.
19. Submission: You are seriously aroused by being ordered around. You must Save not to follow a command and may want to seek out someone who will abuse you and treat you like their slave.
20. Veracity: Every time you deliberately lie, Save or faint.

*) If you actually can, then you believe you cannot.