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One of the many fates worse than death that await you in the Underdark.

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Any examples for this must be taken from published Dungeons & Dragons material, not your personal experiences in a game.

See Pathfinder, Ravenloft, Dark Sun and Scarred Lands for those particular settings.


  • In AD&D standard 2nd edition, minotaurs are usually held captive in labyrinths by "an evil wizard or a tyrant" and are often provided "prisoners and slaves on a regular basis." "Minotaurs [also] breed with human females to produce offspring, which are male minotaurs." It is unlikely that these human females consented to sex.
  • The mimic is a shapeshifter which can disguise itself as anything made from stone or wood. Traditionally depicted as chests, they can also appear as doors or stonework. Touch them and you're stuck to their natural adhesive, and they beat you to death with their pseudopods. Metal Mimics can imitate metal as well, illuminate themselves, and disguise themselves as valuable artifacts. Thankfully, their "eyes" are vulnerable to sunlight. House Hunters don't have the sunlight vulnerability, and can disguise themselves as a building, including light and noises. Several usually work together to form a "village". And then 2nd Ed rolls around...
    • Even worse in 4th edition. Item-mimics are the juvenile stage. Adults pretend to be people.
  • The Ooze is a gelatinous Blob Monster whose main method of attack is to digest you alive. The 3.5 Monster Manual has a particularly demonstrative picture of a poor chap who fell victim to the monster's grasp...
  • Vargouilles are essentially flocks of flying Shrunken Heads that kiss you and, if you aren't quickly healed, turn you into a flying Shrunken Head. Not even you as in all of you, just your head sprouts wings and breaks off. Added to this is the fact that, while sunlight can delay the transformation, the only cure is a level 3 spell, while the Vargouille is low enough a challenge rating that you may only have level 1 spells available when you encounter it.
  • Quippers. Imagine really big piranhas that survive in cold water. Now imagine: you're walking by a pool, and then a giant fish with sharp teeth jumps out and devours you in one big gulp. And they can be anywhere. Paranoia Fuel, anyone?
  • The Dharculus is a dual-planar aberration that stalks prey from the Ethereal Plane, then inserts its toothed tentacles into the Material Plane to grab its victim before biting with its enormous maw. Or from an adventuring party's perspective, suddenly six pale, eyeless eel-like things come thrusting at you out of thin air, with the suggestion of a vague something behind them. They grapple one party member, who then jerks and screams as chunks of their flesh disappear in splashes of blood.
  • The Tarrasque 48d10+594 hit dice points. You're already dead.
  • The Derro were always a race of batshit insane lunatics, but 4th Edition has brought their insanity, and their scariness, up to eleven. Pale, blank-eyed dwarf-like creatures that always cackle and drool no matter what they do, their link to the Far Realm allows them to "warp" their slaves into tentacled monstrosities who barely retain any of their past features or memories. So malicious and mad are they that even the Drow will drop everything and work together to fight the Derro, because they know that if they even so much as let them get a foothold, it could mean the end for them.
  • Beside their morbid origins, the Yuan-Ti doesn't stand up much from other evil slaver races such as the Drow... That is, until you find out about the Yuan-Ti Broodguards and how they are made: A captured humanoid is forced to drink a special elixir, after which they transform into a barely sentient lizard-like creature with a compulsion to follow orders, an instinctual hatred of all non-reptilian creatures and an unwavering loyalty for their "Masters", making them the perfect slaves and capable guardians for yuan-ti eggs. Not only is this transformation anything but pleasant, but by the end of it whoever the person was prior to being force-fed the poison is dead and gone, replaced by the obedient reptilian monstrousity their body has become. Only a wish or miracle spell is able to return a broodguard to its original state after the transformation already took effect, and even then the individual's intelligence is permanently reduced.
  • 5th Edition revamped the Nothic from a rather silly-looking cyclopean lizardman to a wizard who pried too deeply into forbidden matters and is now a sadistic Seer able to just know things about the people it observes — it doesn't even need to read your mind, it just knows. It deals necrotic damage with its gaze attack, which is to say it can make you rot from the inside out just by looking at you. And nobody knows what they're planning...
  • Skulks were creepy enough in 3.5th Edition, the descendants of an ancient empire's "untouchables" caste who underwent a ritual to make them truly beyond notice, able to hide from plain sight, move without leaving tracks, and highly resistant to divination magic, all so they could take murderous revenge on the rest of the human race. Then Mordenkainen's Tome of Foes made them humanoids who went soulless from spending too much time in the Shadowfell, leaving them trackless and permanently invisible unless seen in a mirror... though children under the age of 10 can see a Skulk perfectly. As Mordenkainen himself puts it, "Some children have imaginary friends that their parents can't see. Sometimes these invisible friends aren't imaginary."
  • Rot Grubs are parasitic maggots with Lamprey Mouths that feed on flesh and nest in corpses. They move in swarms, and if they burrow into your skin your only chances at survival are to quickly cauterize the wound to stop their spread or to hope that your cleric has any "cure disease" spell prepared. Once they reach the heart, that's it; you are dead. And good luck at getting revived now that your body is a breeding ground for more rot grubs that your friends will have to remove if they want any resurrection spell to work on you, risking getting infested themselves as well...
  • The Sorrowsworn are personifications of all the negative feelings of people in the Shadowfell: The Hungry, the Lost, the Angry and the Lonely. The portraits make them look like Mooks, but when you look at the CR, each would be a challenge for lv. 10 players. These things are so miserable that you almost feel sorry of them. But don't worry, you can help them. In fact, they're not giving you a choice...
  • Boneclaws are the result of the ritual used to create liches going horribly wrong, creating a freakishly powerful, emaciated creature with Absurdly Sharp Claws. These monsters will latch onto the nearest evil being they can find as a servitor, even if the host does not realise it. Mordenkainen's Tome of Foes provides a horrific example in the form of a boneclaw latching onto a child and acting on their subconscious desires, leading to it murdering people (most likely commoners who stand no chance against a CR 12 monster) the child dislikes.
  • Planescape introduces the Vaath, an intelligent, fiendish wolf-roach which paralyzes prey, then uses a tentacle with a sphincter-mouth on the end to burrow through their flesh and feed on choice organs while the victim is still alive. That's not the worst part - the thing is also telepathic, so it broadcasts its enjoyment of the meal, along with the flavor and texture of what it's eating, to everyone within range, including the victim it's eating. And nobody, not even those from the most vile of cannibalistic cultures, is immune to the horror of learning what their own intestines taste like.
  • The 3.5 Epic Level Handbook brings us the vastly disturbing Atropal, which is quite literally an undead, stillborn godling. Not only is it one of the most potent undead monsters in the game, bits of its sloughed-off flesh can reanimate as less powerful but perhaps even more disgusting Atropal Scions. And the 4E version is quite possibly even worse.
  • Most of the obyriths in the first Fiendish Codex just look wrong, for the simple reason that unlike the tanari'ri that rule the Abyss now, the obyriths all predate intelligent life on the Material Plane. Pale Night, however, looks strangely normal, appearing only as a floating, shrouded female figure... well, not quite. That's not her true appearance, or even an illusion - instead her true form is so horrifying that reality itself refuses to accept it, creating a sort of cosmic censor. If she makes the effort to reveal herself, a lucky onlooker's mind goes blank as they cannot comprehend what they're seeing. The unlucky ones just die outright, and if revived have no memory of what they saw.
  • Lets run through the monstrosities detailed in Lords of Madness: The Book of Aberrations, shall we?
    • Aboleths are giant, tentacled eel-things that, on top of being psionic powerhouses, are surrounded by a cloud of mucous that makes other creatures require water to breathe rather than air, and their tentacles drip with slime that turns victims' flesh translucent and forces them to be immersed in water or take damage. They like to use surgically-implanted grafts to improve their enthralled servants' physical capability while making them more susceptible to psionic domination, or create servitor races like amphibious Skum through forced breeding programs. They gain memories from things they eat, and themselves inherit perfect Genetic Memory from their parent, and their parent's parent, and so on through the eons. Aboleths in fact remember a time when they ruled the world, before the current crop of mortal races - or even deities - contested their rule. They're not happy about the current turn of events.
      • Also mentioned are the Elder Evils that the aboleths pay homage to, the closest they'll come to worshiping something. They're impossibly ancient, godlike in power, and utterly hostile to all normal life. They're not from the Far Realm. They're from somewhere beyond, and they created the Far Realm. The parallels to the entities of the Cthulhu Mythos are quite deliberate.
      • While it's mentioned further down that Illithids make Aboleths uncomfortable, the same applies in reverse, as Aboleths cause great fear in Illithid colonies. Imagine a culture based entirely on psionic power, where psychic abilities are part of everyday life. Now imagine that somewhere out in the underdark, there's a gigantic fish monster that's more powerful than twenty Illithids. The Aboleths have some of the strongest psionic power in the universe, they're organized, and have only been held back by their solitary way of living. But in the Sea of Stars, there's an entire city of them that worships an Aboleth Queen that may as well be a God, and their Chuul armies continue to grow...
    • Illithids, better known as Mind Flayers, are lavender-skinned, slimy, psionic Cthulhumanoids that eat brains. In game terms, they can stun victims with a mind blast and then bite their brain out of their skull with a coup de grace attack. They reproduce by inserting a Mind Flayer tadpole into a victim's facial orifice, which then burrows into their head, consumes the victim's brain, and fuses with their nervous system to transform their convulsing body into a new Illithid. Their society is ruled over by giant psychic brains with tentacles, formed out of their own corpses, which can effortlessly detect both any internal treachery or external intruders. Aboleths consider them unsettling because they don't have memories of Mind Flayers' origin, and the reason why is simple - Illithids are from the distant future, where they ruled a universe of dying stars, and shunted themselves to the present time to avoid catastrophe and get jump-started on forging their empire.
      • This puts a disturbing twist on the "Illithid Heritage" feats available in the Complete Psionic. In most cases, Heritage Feats reflect an extraordinary ancestor like a dragon or outsider, but in the case of the illithids, it means a character may be the product of the mind flayers' sinister experiments... or, if the traits came about naturally, then they're a distant ancestor of the future illithid species.
      • Illithids have a problem - they want to eat as many brains as possible, but it's impractical to "farm" sentient slaves for food, and brain raids never bring back enough prisoners to satisfy everyone. The solution is "performance eating," where one lucky Illithid brings a choice captive to an amphitheater, then eats its brain in front of an audience while psychically broadcasting the sensations of the experience. Hope no infiltrating heroes happened to be passing by during the "show."
      • The only thing worse than the Illithid life cycle is what happens when it goes wrong. If a Mind Flayer settlement is raided and destroyed, all the Illithid tadpoles that live in the Elder Brain's pool are left to prey upon each other until one dog-sized tadpole remains. Eventually hunger will drive it to crawl onto land, where it begins hunting small animals of the Underdark, growing with every meal. If it ever manages to take down a sentient creature, eating its brain triggers the normal Illithid growth spurt, but without a host body to fuse with, the tadpole just grows and grows until it's a colossal, tentacle-headed worm capable of spraying acid that liquefies victims except for their brains. These Neothelids are sentient and just as brilliant and psionically-powerful as any Illithid, but ignorant of their heritage, and willing to prey upon their own progenitors.
      • The 3.5th Edition Monster Manual V details how a Mind Flayer nautiloid ship set out to explore the furthest reaches of the Astral Plane, accidentally entered the Far Realm, and encountered something - a god, a philosophy, it's unclear - called Thoon that profoundly changed them. These Illithids display greater morphology than their base race, are obsessed with gathering a substance they call "quintessence," and use various biomechanical horrors to help with their schemes. Thoon Infiltrators are small clusters of metallic tentacles that act as Puppeteer Parasites, burrowing into a creature, killing it, then replacing its brain and repairing the host body to serve as a spy. They can convert other creatures into Thoon Thralls that are similar, except these variant parasites leave the host intact and self-aware, but compelled to obey any Thoon Infiltrator's commands. They're usually forced to undermine their own communities so the Mind Flayers of Thoon can move in and take what they want, and in combat can be made to go into "Overdrive Healing" mode, which causes them to blister and swell as their body heals damage at a supernatural rate... and once their temporary hit points exceed their normal HP total, they explode in a fireball. Not only is this process irreversible and always fatal, but most Thoon Thralls welcome it.
    • Beholders are insane, paranoid and xenophobic brings with an array of powerful spell-like abilities and the ability to shut down enemy mages with a cone of antimagic. Some are nearly crippled by the conflict between their rational and intuitive minds, others are "sane" to the extent that they can form complex plans, but all are homicidally hostile toward other Beholders because they look wrong, i.e. different... except in the cases of so-called "Hive Mothers." These Beholders can dominate lesser Beholderkin and force them to cooperate, leading to the terrifying prospect of entire cities of the monsters.
      • There's two different accounts of Beholder reproduction, and neither is pleasant. The one from 3.5th Edition describes how a Beholder will spontaneously self-impregnate and gorge itself until its womb - within its head, like all its other organs - swells so that their tongue protrudes grotesquely from their fanged mouth. Then they vomit out this floating womb, which ruptures into a swarm of miniature Beholders. The proud parent scrutinizes its offspring for those that most resemble it and chases them off, then eats the rest for looking wrong. The 5th Edition sourcebook Volo's Guide to Monsters in contrast describes how Beholders can spontaneously create more of their kind simply by having a vivid dream about another Beholder. Sometimes these dreams are mixed with other thoughts, such as musings on the sea or fears of blood loss, which results in Beholder variants such as Eyes of the Deep and the Death Kiss. Other times a Beholder dreams of multiple copies of itself, resulting in a "hive" of Beholders so similar in thought and temperament that they are able to cooperate effectively.
    • Neogi are essentially man-sized wolf spiders with eel-like heads and necks, and are the ultimate slave traders, able to psychically enthrall victims, load them up on their spider-shaped starships, and sell their captives on distant worlds. They reproduce by injecting an elderly Neogi with venom and depositing eggs into this "Great Old Master"'s body, causing it to become an enormous, bloated, barely-sentient creature filled with growing Neogi. Then the newborns devour it from the inside out.
    • Grells are more or less floating, tentacled, beaked brains that view all of creation as one big smorgasbord. The difference between "civilized" and "feral" Grells isn't whether they eat intelligent beings, it's whether they live in colonies and pursue their alien version of wizardry. The most sophistication they've shown in their interactions with other races is herding captives into a "larder" and letting one lucky soul choose who gets to be eaten next, with the understanding that they'll be saved for last.
    • Tsochari are masses of tendrils that covet other species' arcane magic, and are capable of burrowing inside other creatures to act as Puppeteer Parasites. The "lucky" victims are merely ridden, and get to obey the Tsochar's commands or be put through indescribable torment by something writhing within their flesh, while the unlucky ones are devoured from the inside so the Tsochar can inhabit their corpse for as long as it lasts.
    • Oh, and there are about a dozen Eldritch Abomination gods like Mak Thuum Ngatha, Tharizdun, and Y'chak, many of which are utterly insane Expies of creatures from H. P. Lovecraft and would gladly crush the universe. These are all supposed to be happening on the same universe.
  • There's a reason the Book of Vile Darkness comes with a label about "content intended for mature audiences only," and not just because the book's illustrations are borderline Gorn.
    • The book introduces several races of "pure evil." The Vasharans are the Psycho Prototype for the human race, totally incapable of experiencing emotions like love, kindness, remorse, or pity. They're so evil that the only reason their society is able to function is because they're united in their goal of deicide. The Jerren, meanwhile, were an ordinary halfling community that was losing a war against goblins, until they resorted to unholy rites and battle tactics that horrified even the goblins. Now they're Absolute Xenophobes known to ritually sacrifice and devour anyone who enters their lands.
    • One of the book's sample NPCs is The Dread Emperor, who keeps children chained to him so that he can gain a minor benefit, and his armor allows him to shunt any damage he takes onto the kids in question - and he's never seen with the same set of children twice. He's also violently insane, and willing to blow apart a village should anyone suggest that he is not in fact the emperor of all he surveys. And of course he fights without restraint should any would-be heroes attempt to rescue one of his child captives.
    • The book's spells are no better, with names like mind rape, wall of eyeballs, or rapture of rupture. Then there's eternity of torture, which in addition to causing excruciating pain for as long as it lasts, sustains all the victim's needs such as food, drink, and air, while suspending aging.
    • The book also contains the lovely spell Apocalypse from the Sky, which affects everything in a ten-mile radius per caster level - and, being a ninth level spell, the minimum radius is thus 170 miles. Merely preparing it deals 1d3 Wisdom damage to the caster, and actually casting it deals 3d6 Constitution damage and 4d6 Wisdom Drain to the caster, in addition to the 10d6 damage the spell inflicts to everything in its radius. And if that wasn't bad enough already, the huge amount of deaths it usually causes will call forth Atropus, The World Born Dead, which is detailed below.
    • One of the book's "ordinary" magic items is the iron maiden of preservation, which deals 1d6 damage each round to anyone locked inside... and also heals 1d6 damage each round, to prolong the experience. Then there's the major artifact, the Despoiler of Flesh, a rod made up of dozens of stitched-together tongues, which are magically-animated and twitch and flex. It functions as a superior polymorph other spell, except not only can you change one creature into another, you can change aspects of that creature - swapping arms for tentacles, teeth into toes, adding useless insect legs, whatever your twisted imagination can come up with. Unlike with the baleful polymorph spell, the victim gets no save bonus to resist the effect if the new form isn't viable in their current environment, and if they fail their saving throw, they just collapse into a mass of twisted flesh and expire. Oh, and the Despoiler of Flesh's most famous wielder was a despot who lusted for his own daughters, but instead of forcing himself upon them, he transformed captives and slaves into likenesses of his daughters and raped them instead.
    • Most importantly, the Book of Vile Darkness that this sourcebook is named after? One of the most prominent examples of evil literature? Turns out it got its start when a Vasharan one day decided to start writing a diary of the messed-up things he did. "Big things have small beginnings", indeed.
  • The Libris Mortis has some "fun" spells involving necromancy. Avasculate is bad enough for making the victim violently purge blood through their skin, but avascular mass takes it up a notch by making them purge their blood vessels through their flesh, magically animating the mass of arteries and veins, and using it to make a grisly, entangling web of bloody strands. And then there's the necrotic cyst line, which starts with creating a little sac of necrotic tissue within a potentially-unsuspecting victim, which can then serve as the focus for nastier spells - using it as a scrying point, using it to dominate the host, using it to damage the host, and so forth. The climax is the spell necrotic eruption, which either deals massive damage or kills the cyst's host outright, creating a Skulking Cyst in the process, a free-roaming magical tumor trailing rotting organs behind it.
  • Most of the Elder Evils readily qualify for this. It's strongly advised you only read this book in dark rooms, so that you don't have to look at some of the pictures.
    • Pandorym? It's an Eldritch Abomination from a reality perpendicular to the game world, and it's going to kill the gods and a fair number of planets too — and Obligatum VII, one of the representatives of universal law, wants to release it to fulfill a freaking contract.
    • Father Llymic? He's a monster from the Far Realm who will transform the entire world into ice, transforming most of its inhabitants into hybrids of themselves and insects.
      • Father Llymic may not look particularly threatening, but the fluff they built up around him is sheer nightmare fuel. Back when your flavor of ancient magical empire Dug Too Deep, and created a portal to the Far Realm without knowing the consequences. This allowed a number of Far denizens into the Prime Material Plane (and may be the origin of aboleths and similar aberrations in that realm). Thankfully, while the Far Realm is not particularly habitable to us, it turns out the same is true the other way around. Specifically, Llymic is weakened by light, and when he's exposed to it, he radiates extreme cold. The ancient elves exploited this, and imprisoned him in ice on the highest peak of the highest mountain, where the sun's rays would keep him imprisoned forever. He psychically manifests to people as an elderly elf male who points you to the mountain where his body is imprisoned, and may become hostile if ignored. If you spent too much time near him ("near" here means a few kilometers) or come into contact with his spawn, you may be transformed into horrifying ice monsters that worship him feverishly. The scariest part about Llymic, however, may be his signs. It starts out simple. Longer winters, a few people go missing, that sort of thing. This is D&D, where children are kidnapped by wererats every other week, so most people won't notice. Maybe an adventurer or two is sent after them, and get to slay one of Llymic's spawn and call it a day. Over time, the cold gets worse and worse. The glacier on the mountain starts moving at a heightened pace, and the villages nearby become uninhabitable. Llymic's spawn start to spread, and cults form to worship him. When the powers of the land can no longer ignore this, the worst signs become noticeable: Slowly but surely, the sun starts to dim, and magic that produces light stops working. When Llymic fully awakens, the sun has fully gone out.
      • Oh, and extra horrifying? Unlike many of the Elder Evils, Llymic does not appear because summoners call him or cults worship him (they do, but that comes later). It could happen anytime.
    • Ragnorra? She's a giant wormlike sack of flesh that transforms into a True Mother form, and she not only spawns an infinite stream of crimes against nature that make beholders and mind flayers look pleasant, but The Dragon is a maddened zenythri (for the uninitiated, these are the descendants of humans and beings of pure law) who has cut his lips off and replaced them with wriggling flukelike critters.
    • Sertrous? He's not so bad by himself, but his manifestation flooding the world with serpents, and he can can never really be defeated, as he's already dead.
    • Kyuss, The Worm That Walks? Let's just say you may never look at a worm in the same way again.
    • The Hulks of Zoretha? They're multiple, intelligent, and nothing that is alive and thinking can avoid their Hate Plague, so every living creature must spend every waking moment trying not to murder everything in sight.
    • And of course let's not forget Zargon, the last member of the devil race before the baatezu. Not only is he a vile-looking creature, but he creates a pool of poisonous slime wherever he goes. Plus, he is pretty much unkillable, as in the gods asked Asmodeus to take him down. Which even he couldn't do in the end, as he couldn't find the pit that you have to pitch Zargon's horn into to actually destroy him for good; it wouldn't hurt to mention that you have to do this within a DAY of taking him down, or that his horn makes him practically indestructible in its own right. Especially the golothoma, an eyeball-spider-serpent-thing that eats you with its shadow.
    • And finally, there's Atropus. This Elder Evil's moniker is "The World Born Dead" — a godling formed from the figurative afterbirth of the universe that takes the form of an entire planet made out of undead flesh, bone, and corrupted elemental matter. Its surface teems with swarming armies of undead, and Atropus is defined first and foremost by its unquenchable hatred for all life, which sees it roaming the universe, causing a Zombie Apocalypse on any world it approaches, hoping to annihilate all life and replace it with undeath. As if that weren't enough, Atropus takes the form of a planet with a face: a vague, shadowy semblance of a skeletal face, visible from orbit, with a hollow mouth gaping in an eternal scream of hatred.
      • Oh, and those Atropals we mentioned earlier? The stillborn gods? They all came from Atropus.
  • Heroes of Horror. Exactly What It Says on the Tin: an entire sourcebook for adding Nightmare Fuel to campaigns.
    • The Unholy Scion is a horrific little example of Demonic Possession. Usually created when a fiend possesses an unborn baby, the result is truly a Fetus Terrible; it's aware and sentient even in the womb, and has a permanent Charm Person effect on its mother. Naturally, being a demon, it likes to make its host-mother do all sorts of terrible things for its own amusement, something a sadistic Dungeon Master can really have some "fun" with. Imagine a beloved pregnant matriarch whose many loved children are disappearing... and then imagine it's because she's eating them at the behest of her unborn child, simply because it amused it. Worse, the mother is perfectly aware that what she's doing is wrong, but the unnatural love for her child forced upon her by its powers leaves her helpless to resist.
      • And it doesn't get any better when the Scion is born. It just graduates to the position of Enfant Terrible. Now you have the lovely scenario of a perfectly normal baby who uses both its permanently-besotted mother and its own array of Black Magic powers to guard itself until it's physically strong enough to enact its corrupt and sadistic urges.
      • Oh, and the icing on the cake? You can't exorcise an Unholy Scion. Attacking a body with such an underdeveloped soul means the fiend effortlessly absorbs the original spirit. From an outside perspective, there's nothing to exorcise. You can only kill it when it's born... or perhaps, before.
      • Oh, and it gets worse! See, whilst most Unholy Scions are created through deliberate Demonic Possession by fiends, they can also form spontaneously. If a woman happens to conceive through union with a fiend in an area of high Taint, then the result is always an Unholy Scion.
    • The sourcebook also comes up with some horrific twists to put on familiar enemies. Consider an arrogant red dragon that wants to create some half-dragon offspring, but insists upon kidnapping humanoid princesses and queens to ensure that he has only the best stock for his Breeding Slaves. Or a community of Illithids so jaded that they have their thralls engage in an orgy of sex and violence while they levitate over the writhing mass of slaves, drinking in their thralls' emotions.
    • The book's Taint mechanic can lead to characters being corrupted just by coming into contact with evil creatures, artifacts or locations. Mental corruption starts with things like your aggression giving you a -1 penalty to your Armor Class, or your self-absorption making you always flat-footed at the start of an encounter. Severe mental depravity can make you so murderous that you must always perform a coup de grace when possible, whether against a friend or foe, or so mentally-unbalanced that you are confused during the first round of combat. Then there are the physical symptoms of Taint, the mildest of which include cloudy eyes, rotting gums, palsy or a constant fever. Severe physical corruption can cause your eyes to rot away and leave behind green lich lights, parasitic worms protruding from your open sores, a black lichen spreading across your skin, or your body simply bloating and swelling with foulness.
  • Dragon magazine occasionally got into this too. One issue featured several spells designed to evoke that "insane asylum" feel, up to and including a lobotomy. About the only reason it's possible to sleep after seeing that is to consider the Shout-Out in the opening flavour text features a "Dr Gregorian Ilhousen", a Hilarious in Hindsight moment. note 
  • Eberron contains quite a few nasty devices used by the more malicious/insane antagonists:
    • The Husk of Infinite Worlds, a magical device used by the daelkyr to create new species of creatures by horribly mutating others. Think of it like a DNA washing machine: creature goes in, gets put on the spin cycle, and if it doesn't immediately dissolve into primordial ooze it pops out in a new, horribly mutated state. Even then, there's only a 1% chance that the new form will be able to survive for longer than fifteen seconds. And if it does survive, the daelkyr in charge will likely just put it in again to see if it can mutate into a more interesting form.
    • Everything the daelkyr do qualifies as Nightmare Fuel. These are people whose main slave race was created by fusing two goblins together. These are people who bred a variety of abominations to use as clothing, including a suit of armour that's actually a limbless crab. These are the inventors of the aforementioned beholders and mind flayers.
    • The Lords of Dust have devices that can turn any creature into a willing slave by pumping them full of magical sand. Here's how the process works: the subject is placed into the device — which resembles a sarcophagus — which is then sealed shut. Suckers emerge from the inside of the device, attach themselves to the victim, then proceed to suck out their soul. Once the body is completely drained, those same suckers pump the empty husk full of magical sand that turns the body into a willing servant of the Lords of Dust. Finally, the victim has a key installed in their eye socket that, when turned, will stir up the sand and grant increased strength and speed. The passage mentions that the Lords of Dust particularly love to inflict this fate on their worst enemies. Looks like whomever put these things into Eberron canon liked to watch and/or read Hellboy, doesn't it?
    • One question posed to the setting creator was "Why do daelkyr look so human?" His response was "The question should be 'Why do humans look so much like daelkyr?'"
  • The Urban Arcana campaign setting combines fantasy and realistic settings. It includes familiar monsters from Dungeons & Dragons, which is fine...and then there's the new ones. Such as the "Urban Wendigo". A homeless person's bitterness and sense of disconnection from humanity eventually causes them to degenerate into a subhuman, Morlock-like beast that, while still looking essentially human, preys on lost people in the city. And just think: ANY homeless person could be one of them...
  • The d20 sourcebook Dragonmech. A D&D type world where the moon has been moved closer and almost all life lives either deep underground or within truly Humongous Mecha , the City-Mechs up to 2000 feet tall, powered by magic, steam, clockwork... slavery, or necromancy. One of the undead 'mechs' is described as being thousands of bodies melded together... but some of the smaller ones are creepier. A meatrack is a metal skeleton with sharpened fingers as its weapons, that is powered by bare muscles attached to the frame. But even the undead ones aren't the worst... one of the character classes is a steampunk cyborg... that modified himself. Break a leg, why wait for it to heal? Hack it off and replace it with some metal... well, now you're lopsided, so you might as well do the other side too... Man, this would be easier if I could change out my hands, why not replace the arms too? Until you're left with a head on a robot body... and the steampunk cyborg did all of the work himself, aside from the implantation of the original small steam engine, was forgotten. The amputation of limbs and replacement with metal, with no mention of any sort of anaesthetic.
    • The self-mutilation mentioned above was added as an Artificer feat in 3.5 Eberron, aptly named "Self-forged". As in, a Warforged that forged itself. You keep your original race for a while, but eventually your self-modification will cause your character to become almost entirely Magitek.
  • We all know the stars, right? Big balls of light that you see in the sky? Well, in 4th Edition, quite a few of these stars are actually alive, and they are not our friends. These living stars are pretty much Eldritch Abominations that have one goal: annihilate the World and everything on it. Some of them are capable of creating humanoid avatars of their powers. These "Star Spawn" are all horrific in their own right.
    • The Herald of Hadar is a corpse-like figure with red orbs for eyes and wicked-fast claws. Worse, all he does is eat, eat and eat. Represented by a fat monster? Nope. The herald of Hadar is clearly starving.
    • Like the Herald of Hadar, the Scion of Gibbeth's sole purpose is to eat, but that's not what makes it horrifying. The picture we're given of it shows a pitch black demonic figure encased in an amorphous, corpulent shell, but that's still not what's horrifying about it. No, what is horrible about it is that this disgusting, dual-skinned form isn't the Scion's true form at all. The Scion of Gibbeth is so alien, so mind shatteringly disgusting and horrific, that no one who sees one ever sees the shape another person would see. Makes Pale Night look like a loving, friendly mother.
    • The Maw of Acamar is a giant, human-shaped void that leads into the depths of space, you can clearly see stars, and whole galaxies in the tear. Oh, and what is Acamar? It's implied to be a sentient, evil, black hole. One day, it might eat the world.
    • The Spawn of Ulban is a humanoid figure covered in purple chitin. Instead of legs, he's got seven tentacles (still purple). His hands are covered in cold, blue fire. He's more powerful than some gods, and what does he do? He destroys small kingdoms. And no, he isn't a One-Man Army. His sheer psychic presence makes people go crazy. And the worst part is that its master, Ulban, is not himself evil: he's trying to prevent The End of the World as We Know It from happening. But if Ulban isn't evil, then why are his Spawn the way they are? And why can he not hold them back?
    • So your players are engaged in a diplomatic endeavor. They are very lucky, 'cause they have one of their nation's best diplomats on their side. With Errol Flynnish good looks, he's the life of the party, and all the while he steers the debates in your favor. But something seems off, he has a weird accent, or odd syntax, or he steps just a little into Uncanny Valley. The PC's investigate. It turns out that this guy just popped up recently, and just in time, as a mysterious plague is sweeping the nation, and the cure lies in the hands of enemies. So this guy comes in to save the day. And then the PC's learn the awful truth: this "friend" is actually a Defector from Decadence, and his enemies are hunting him down. Won't the PCs please protect him? The plague intensifies, and kills a friendly diplomat. The other nation is struck, and refuses the to share the cure. The two nations go to war, while the dead mount. A whole continent is dragged into despair, and as the heroes look on, helpless, a purple star rises in the sky. What happened? Well, the nice diplomat was an alien monster all along. That's an Emissary of Caiphon, one of the more powerful of the star spawn. And Caiphon is revealed in a Dragon article to be the nicest of these things. He is implied to not hate you, he is just curious as to what happens when you remove part of the social foundation. Sometimes he eradicates horrors like, say, slavery, and other times he eradicates entire sentient species.
    • The Serpents of Nihal, whose origin reads like an H. P. Lovecraft short story. Once there was a jungle nation, devoted to the evil god of Snakes, assassins, darkness, and poisons. Now, this nation of Aztec Expies searched for more power. So, they opened a gate to Nihal, a a star made of snakes, and the Spiritual Successor to Kyuss up there. What came out? An army of glowing, evil snakes.
    • And then there is Allabar, Opener of the Way, the first 4th Edition living star we get a close look at. Remember what Atropus looked like? Well, instead of a face, imagine dozens upon dozens of unblinking eyes, as well as hundreds of rope-like "growths" around its "body." Think the moon, when it's nice and big and clear, so you can see all of the faultlines, valleys and craters. Now imagine every faultline and valley is a huge, thrashing tentacle, and every crater, from the biggest to the smallest, is a never-blinking eye. Imagine that floating in the sky above you at night. Staring at you. Hating you.
  • There is something mildly unsettling about the 5th Edition cantrip toll the dead. The sound of a tolling bell is heard out of nowhere, and all of a sudden, the target is missing a chunk of health for no apparent reason. Also, it's necrotic damage, which means it likely damages the very soul of the target.
  • The level 9 Warlock/Wizard spell imprisonment is And I Must Scream Incarnate. Buried deep under ground for all eternity? Bound with unbreakable chains? Eternal sleep? Your own, inescapable pocket dimension? Shrunk to the size of a pin and placed in a gemstone for viewing pleasure? Pick your poison. While imprisoned, it's nigh impossible to escape, and the spell negates all forms of teleportation, including planar. Your only hope is that your captor is nice enough to provide a set of conditions for your release (which can be anything from True Love's Kiss to When you agree to do what I say), or your party has a 17th level spell caster available. Or a Wish scroll. Of course, Lv. 9 spells are hard to come by. Let's hope you were nice to your teammates.
  • The story of the Duergar (pictured above) is that they started obsessing over digging deep under their citadel. This obsession became so strong that they abandoned their temples and left the weak to die while the strong dug on. Turns out they were digging into a Mind Flayer colony. To make it worse, when they finally escaped thanks to their great hero/god Laduguer, the other dwarves had turned their backs on them because they abandoned Moradin. The priests of Moradin even went so far as to accuse the duergar of bringing the illithids upon themselves.
  • The psionic power mind seed is a very insidious example. When you use it on someone, if they fail a Will save, you implant a little bit of yourself in their mind. Over the next week, it unfolds, bit by bit. Gradually, they start taking on habits they never had before... but if someone who knows you saw them, they might recognize it. And they don't even notice it. It just feels natural. (For example, if you roll your head to one side before lifting something, they might start doing that, too.) At the end of the week, the seed blossoms... and that person is gone. Completely. Instead, they've become, for all intents and purposes, a perfect copy of you, as you were when you used the power on them, but in a different body.
  • On the topic of Mind Rape spells, there's also the infamous Feeblemind, which takes the Stupidity-Inducing Attack trope and takes it straight into And I Must Scream territory. If a target is hit with the spell and fails the saving throw, both their Intelligence and Charisma scores are reduced to 1. They can't talk, can't cast magic, and can't understand spoken language. On top of that, if they aren't healed by outside magic, they can only attempt to repeat this saving throw once a month (which is going to be hard to begin with, since they now have a -5 modifier in intelligence).
    • The spell's description says that it "shatters [the target's] intellect and personality". Let that sink in.
  • Curse of Strahd was an attempt to make vampires scary again, with writer Tracy Hickman saying "The vampire we see today exemplifies the polar opposite of the original archetype: the lie that it's okay to enter a romance with an abusive monster because if you love it enough, it will change." By contrast, Strahd does not mess around. The sky is constantly dark, the woods are dying and blighted, the people are constantly miserable and mostly literally soulless, and Strahd's true threat is felt constantly. And if your characters die? Their souls can't even leave for the afterlife, because Strahd's dark power controls everything. Everything. Imagine being hunted by a creature where not even death can save you. It's even said in DM notes for the campaign that characters who come back after being killed suffer a level of madness because they realize the implications here.
  • Doomed Forgotten Realms is a Villain World where every adventure Wizards of the Coast ever released resulted in the villain winning, all of them, try to think about the implications of that.

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