Ability Damage, Ability Penalties, Ability Drain, and Negative Levels

Some monsters can cause ability damage, which penalizes one or more of your ability scores. This can add up quickly, so you need to track the total ability damage you’ve taken to each ability score.

For every 2 damage you take to an ability score, reduce your ability modifier by 1 for skills and other statistics affected by that ability. If your total damage to one ability is equal to your score in that ability, you cease taking damage to that ability score, but you fall unconscious until the amount of damage is less than your score. However, if you take Constitution damage that equals your Constitution score, you instead immediately die.

You recover from ability damage to each affected ability score at a rate of 1 per day. Spells such as lesser restoration can also heal ability damage.

Reductions to your ability score modifier from ability damage affect skill checks and ability checks that use that ability score, as well as on the DCs of spells and other abilities based on that score. If you take damage to your key ability score, you also lose 1 RP for every 2 damage you have taken to that ability score. The entries below describe other rolls affected by the reduced modifier.

Strength: Attack rolls that rely on Strength (usually melee or thrown) and weapon damage rolls that rely on Strength (usually melee or thrown).
Dexterity: Armor Class, attack rolls that rely on Dexterity (usually ranged), initiative checks, and Reflex saves.
Constitution: Fortitude saves. You also lose a number of Stamina Points equal to your level for every 2 damage you have taken to Constitution. For example, if you’re 4th level and you took 5 Constitution damage, you’d lose 8 SP.
Wisdom: Will saves.

Sometimes you might take a penalty to ability checks or to an ability score, rather than ability damage. These penalties affect your modifier the same way as damage, but they are only temporary and can’t result in your falling unconscious or dying.

More severe than ability damage, ability drain reduces your ability score permanently. Note that this affects your score directly instead of penalizing your modifier, so 1 ability drain changes your modifier if your original ability score was even, but not if it was odd. Modify all statistics related to the ability’s new value. This might make you lose skill ranks along with Resolve Points, Stamina Points and other bonuses gained from having a high ability score. If you take ability drain in the middle of a battle, the GM might have you treat it as damage until after the fight so recalculating your statistics doesn’t slow the game. Ability drain doesn’t heal naturally but can be healed by the restoration spell.

In general, if any ability score is reduced to 0 from ability drain, you fall unconscious. If that score is Constitution, you instead immediately die.

If you have 1 or more negative levels, you take certain penalties and might even die. For each negative level you have, you take a cumulative –1 penalty to your ability checks, your AC, attack rolls (including combat maneuvers), saving throws, and skill checks. In addition, you reduce your current and total Hit Points and Stamina Points by 5 for each negative level you have. You are also treated as 1 level lower for the purpose of level-dependent variables (such as spellcasting) for each negative level you have. If you are a spellcaster, you do not lose any spell slots as a result of negative levels. If your negative levels equal your total character level (or CR, for monsters), you die.

Negative levels are temporary, unless the effect that bestows them specifies they are permanent. If you have temporary negative levels, you can attempt a saving throw each day to remove those negative levels. The DC is the same as the DC of the effect that caused the negative levels. If you have negative levels from multiple sources, you must attempt a separate saving throw to remove the negative levels from each source.

If an effect imposes permanent negative levels, they are treated just like temporary negative levels, but you do not receive a saving throw each day to remove them. Permanent negative levels can be removed through spells such as restoration. If you die, permanent negative levels remain even after you are restored to life. If your permanent negative levels equal your total number of class levels (or CR, for monsters), and you are brought back to life using spells such as mystic cure or raise dead, you remain alive for 3 rounds but then die again if you have not also benefited from a restoration spell or similar effect within that time.