Below is a summary of the derangements portrayed in the V20 book. If none of these fits what you need for your character, speak with a storyteller.


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.

Vampires or mortals receive derangements under conditions of intense terror, guilt, or anxiety. If a player botches a Virtue or Willpower roll (for example, when confronted with Rötschreck), the Storyteller may decide that the experience causes a derangement in the character. Other examples of derangement-inducing events include killing a loved one while in a frenzy, being buried alive as part of a Sabbat ritual, or seeing hundreds of years of careful scheming dashed in an instant of bad luck. Generally, any experience that causes intense and unpleasant emotion or thoroughly violates a character’s beliefs or ethics is severe enough to cause a derangement. The Storyteller determines which derangement a character receives, working with the player to choose (or create) 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 to the monsters that live next door; even something as harmless-sounding as talking to an invisible rabbit can become disturbing to observers. 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. Your vampire’s derangement is there for a reason, whether he’s a Malkavian who resided at Bedlam before his Embrace or a Ventrue pack member 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.

Bipolar Disorder

Bipolar individuals 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. Kindred with this derangement are constantly on a hair trigger, never knowing when the next mood swing will strike. Whenever the vampire fails a task, the Storyteller has the option of secretly making a Willpower roll (difficulty 8) for the character. If the character fails the roll, she lapses into depression. Additionally, the vampire will go into depression whenever one of her rolls is botched, or 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 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.


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.

A vampire with bulimia gets hungry much more quickly than other vampires do. When feeding, a bulimic vampire must make a Conscience or Conviction 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, 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.

Kindred 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 determined by 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.


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. 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.


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.” Kindred 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 vampire, 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.

If a megalomaniacal vampire is presented with a realistic chance to diablerize a more potent Kindred, she will be sorely tempted. A Willpower roll (difficulty 9) is needed for the vampire to avoid taking “what is rightfully hers.”

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 vampire 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. Kindred 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.


The trauma, guilt, or inner conflict that causes this derangement forces the individual to focus nearly all of her attention and energy onto a single repetitive behavior or action. Obsession relates to an individual’s desire to control her environment — keeping clean, keeping an area quiet and peaceful, or keeping undesirable individuals from an area, for example. A compulsion is an action or set of actions that an individual is driven to perform to soothe her anxieties: for example, placing objects in an exact order, or feeding from a mortal in a precise, ritualistic fashion.

Vampires with an obsessive-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.


The victim of paranoia believes that her misery and insecurity stem from external persecution and hostility. Paranoid individuals 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.

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 of her victims.

Diablerie would be particularly unwise for an animist. 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 as if the mind of her victim in control. During the moments just before dawn, control reverts to the vampire.


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. 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 or direct frenzy increase by three, and the vampire loses three dice from all Willpower rolls.