The idea here is that these afflictions are meant as character concept guides, plot devices, more interesting character representation, or as means of creating interesting consequences for your players. This borrows heavily from ideas in the prior versions around 'power at a price' concepts, such as body grafts (demon grafts, necrografts, etc), corruptions, curses (particularly, oracle curses) and deliberate acts of self-destruction in order to obtain something. But it also allows for the exploration of disabilities and chronic afflictions seated more firmly in the game setting, which allows for players an opportunity to explore playing characters struggling through a life-altering affliction without actively weakening the power fantasy Pathfinder is known for.
A lot of players are intrigued by the idea of making the game more difficult for themselves for the sake of a more robust roleplay experience and depth to the struggles that their character is faced with, sometimes before any dice are rolling. By providing workable mechanics to assist and guide players and game masters, this also allows for a mechanical representation of the ideas without being forced to operate on abstraction or GM fiat.
Primarily borrowing some prompts from here! https://www.tumblr.com/knives-in-the-dishwater/755097805660569600/ihasafandom-ihasafandom-beleester
Pathfinder 2e has a few methods through which this is possible. We'll make one for a few over several posts.
Backgrounds
Backgrounds serve as a really light-weight method of giving your character a deliberate downside in order to obtain something better in return. This technically will be two different types in one, since we'll be utilizing Afflictions for our example.
This background provides the means of creating a character struggling with a terminal illness without an obvious cure or solution. This is usually a fairly intense subject matter to explore, so it is always best to check with your GM and fellow players before introducing characters that revolve around similar themes. However, for a character motivation, this provides ample ground for the call to adventure, and heroes are rarely the type to give up even in the face of extreme adversity. (You can maybe tell I was recently playing BG3 and maybe a certain character from that comes to mind.)
Threadbare Form
Rare
Your body is no longer capable of keeping itself physically whole. The years of close calls and near-fatal injures held back by the workings of magical healing practitioners has had an unusual and horrific effect on your body. Without the constant application of vitality energy, old wounds and injures start to re-emerge; fresh as the day they happened. You seek a cure to this terrible fate, before your body falls to literal pieces beneath you.
Choose two ability boosts. One must be to Wisdom or Charisma, and one is a free ability boost.
You are trained in Medicine and The Void Plane Lore. You are permanently afflicted by Memory of Injury. This affliction cannot go below Stage 1, even if you successfully save against the affliction. If you are ever exposed to an effect with the vitality trait, and that effect would heal you, then this affliction immediately resets to Stage 1, even if no healing occurred. No mortal magic can remove this affliction outright, and it is dubious what, if anything, the gods can do to help you.
You can cast void warp as an innate occult cantrip. You can use Wisdom as your spellcasting ability for this innate spell. While at Stage 2 or higher of Memory of Injury, add a +1 status bonus to the save DC for this cantrip.
Special If you are harmed by vitality energy and healed by void energy, than the traits of Memory of Injury become (curse, vitality) and all void damage is replaced by vitality damage. Your affliction is reset to Stage 1 and you can only recover hit points from effects with the Void trait,rather than effects with the Vitality trait.
Memory of Injury (Curse, Void) While afflicted, the creature can only recover hit points from effects with the Vitality trait. The creature still recovers hit points from resting. A creature killed by memory of injury splinters into threads of flesh, bone and skin and can't be resurrected except by a 7th-rank resurrect ritual or similar magic. Resurrection does not remove the curse; Saving Throw Easy DC adjusted Fortitude; Stage 1 No effect (5 days); Stage 2 1d4 void damage per two levels (2 days); Stage 3 As Stage 2 (2 days); Stage 4 As Stage 2, but deals 2d4 void damage per two levels instead, return to Stage 1.
Edit: Feedback implemented from @kobold-catgirl, much thanks!
