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A digital artwork with slices of five images arranged in a fan. From left to right they are: a photograph of a character sheet with blue dice and a green pencil, The International Symbol of Access (a blue background with a white stylized image of a person in a wheelchair), a chaotic pile of dice in many colors and styles, splattered rainbow paints with a black and white drawing of a brain on top, and miniature houses with figurines of people in action poses.

A digital artwork with slices of five images arranged in a fan. From left to right they are: a photograph of a character sheet with blue dice and a green pencil, The International Symbol of Access (a blue background with a white stylized image of a person in a wheelchair), a chaotic pile of dice in many colors and styles, splattered rainbow paints with a black and white drawing of a brain on top, and miniature houses with figurines of people in action poses.


I’m going to start by saying that it isn’t inherently wrong to create game mechanics that treat disability as a limitation. However many of the mechanics that exist create dynamics that reinforce negative ideas about disability. The most common problems are mechanics that use derogatory language for disability, fail to represent important experiences of disability, don’t represent disability accurately, create an incentive for players to engage in stigmatizing play, and push players into portraying disabilities that they have limited knowledge of. Altering, replacing, or removing these game mechanics makes it possible to create disabled characters that are respectful and realistic representations.


Disability Isn’t Always a Limitation

This is something that a lot of folks outside of the disabled community are unaware of. The way that I like to explain it is that there are two ways to experience disability: as a limitation and as a neutral difference. To illustrate this I’ll use myself as an example. I have a chronic back condition which I experience as a limitation because it prevents me from doing things, like lifting heavy objects. At the same time, I experience the way my brain works as a neutral difference. My brain is very good at taking in a lot of information and quickly thinking through many options. This ability is a great strength when it comes to analyzing and planning, but the fact that I think about everything so thoroughly also causes anxiety. However, just because I experience my unique, anxiety-producing brain as a neutral difference, doesn’t mean that others with anxiety feel the same.

For many people this is an individual and deeply held experience. When a person with a disability wants to play a character with the same disability, it can be painful to have such a significant experience invalidated. Mechanics that only treat disability as a limitation run into this problem.

Fortunately there is a pretty easy fix for this. Any time the player or character doesn’t experience a particular disability as a limitation, just remove the mechanic and handle it through other aspects of character building and role-play. This involves working through the way that the disabled character lives their life and thinking through any accommodations or assistive devices that they may have. It can be helpful to talk through a few example scenarios.


Inaccurate Mechanics

Because many of the mechanics for disability weren’t created by people with disabilities, a lot of game mechanics do not accurately represent disability. A common problem is mechanics that don’t differentiate between able-bodied characters with temporary conditions and characters with long-term disabilities. For example, a number of games use the same mechanics for both blind characters and sighted characters that have temporarily lost their sight. This is a problem because this is an inaccurate and stigmatizing depiction of what it means to be blind that presents blind people as if they are incapable of functioning. In actuality, blind people have skills and tools that sighted people who have just lost their sight don’t have. “If you want to help the blind, blindfolding yourself isn’t the answer” has a clear explanation of these differences.

In addition to depicting disability unrealistically, these inaccurate mechanics are often overly limiting. By being so limiting, these mechanics reinforce the stigmatizing idea that disabled people are incapable of accomplishing things. This is particularly important because most tabletop role-playing games are about making players feel empowered and disabled players and characters deserve to be empowered too.

I want to be clear that I’m not trying to say that characters with disabilities shouldn’t be affected by their disabilities or that disability shouldn’t ever be treated as a limitation. What I’m saying is that it is important to accurately represent disabled characters and to not base game mechanics on stigmatizing stereotypes about what it means to have a particular disability.

Another way that game mechanics often depict disability inaccurately is by depicting disabilities as one set of symptoms that everyone with the same disability has. This is something that comes out of the way most game mechanics work. In many systems it is easier to create one set of rules that always applies to everyone with a specific disability. The problem is that the idea that everyone with the same disability has the same abilities, traits, or needs is a common myth that causes problems in the real world. When actual people with disabilities don’t match the ideas that able-bodied people have about their disability, they get harassed and called a “faker.” Other times, these assumptions cause able-bodied people to attempt to help disabled people without asking first. At best this is patronizing, and at worst it gets in the way of the disabled person getting their actual needs met.

So what can be done about these problems? One option is to remove the game mechanic and handle the disability through role-play as described above in the “Disability Isn’t Always a Limitation” section. Another option is to alter or replace the game mechanic so that it represents the disability of each character with that disability. Sometimes this means having a different mechanic for different characters. If there are participants in the game who have a particular disability, their experiences should be centered in the design of any new mechanics for that disability. If no one present has experience with that disability, then the new mechanic can be based on research. It is also helpful to look at mechanics for disability that were created by people with disabilities, such as the list of “D&D Disability Mechanics” created by sleepyspoonie.

Finally, there may be situations where a disability is portrayed accurately, but the disabled character isn’t getting the same empowering experience as other characters in the game. This is a situation where a character has accessibility needs that aren’t being met. These needs can be addressed by creating appropriate accommodations and assistive devices. (I am currently writing two articles, “Preventing Disabled Characters from Being Left Behind with Game Job Descriptions” and “Creating Empowering Accommodations and Assistive Devices,” to address this subject in detail.)


Game Currencies

In some games disabilities or assistive devices are connected to game currencies. Some of these currencies create an incentive for players to engage in stigmatizing play dynamics. A clear example of this is Vampire the Masquerade which made specific disabilities into “flaws” that players could take in order to get more points to spend on their character’s skills and abilities. The problem with this is that rewarding players for giving their characters disabilities creates an incentive for players to give their characters disabilities even when they aren’t actually interested in playing a disabled character. A frequent result of this is the dynamic where players give their characters a disability and then use character abilities or magic items to get around the mechanical limitations of that disability. This isn’t an accurate or respectful portrayal of disability. At best it turns disability into a cheap way for players to game the system for more points.

Other game currencies create barriers to characters obtaining the assistive devices they need to fully participate in the game. Most often this is a price barrier that prevents characters from acquiring assistive devices that fully meet their access needs. Having the appropriate assistive devices is essential for portraying characters with disabilities in an accurate and empowering way.

Many of these cost barriers are based on the knowledge that many real-world assistive devices are expensive. However this reality doesn’t make it okay for low income disabled folks to be without reliable and effective assistive technology. In fact, in the real world there are specific charities and resources designed to help people struggling with this problem. When it comes to fictional worlds there are even more options. Not every fictional world needs to have a culture that fails to give low income disabled people consistent accesses to assistive technology. Even in harsh ableist cultures, there are still plenty of creative ways for low income characters to get access to these devices. Maybe they got it from an altruistic charity, or they made it themselves, or they stole it, or a powerful person gave it to them in exchange for three favors. There are many ways to role-play access to an assistive device that add depth to the story, rather than taking away from it.

My suggestion is to handle disability separately from all game currencies, particularly at character creation. This means working out the characters’ disabilities, abilities, assistive devices, and other resources (such as service animals) separately from both rewards and costs. Doing this removes the incentive for negative behaviors and provides the freedom needed to create a disabled character that can fully participate in the game. If this means giving a low income character an expensive assistive device, come up with an explanation for how they got that device.


Mechanics that Force Disability on Characters

In the real world able-bodied and neurotypical people can suddenly become disabled. There are game mechanics that try to simulate this experience. A particularly prominent example is the mental health hit point systems (often called sanity systems) in cosmic horror games. In many of these games, failing a specific roll results in the character gaining a mental illness. Other systems include the possibility for characters to lose body parts or contract incurable diseases.

Unfortunately, simulating sudden changes in ability through non-optional mechanics encourages stigmatizing play dynamics. That is because respectfully portraying disability in a fictional setting requires players to do a lot of work and preparation. The less experience that a player has with that particular disability, the more work they will need to put in to avoid acting out stereotypes. Not every player is up for putting in this amount of work. In addition, even if a player is up for it, putting them on the spot with a sudden change can make players feel pressured into acting out their character’s new disability before they have had a chance to do any research.

What I recommend is changing these mechanics so that each player gets to choose whether or not their character becomes disabled. If the player decides to give their character a disability, they should have a say in what that disability is. In addition, when a character suddenly gets a disability, a short break can be provided to give the player time to do a bit of initial research on how to respectfully portray that disability. For those players who aren’t up to portraying a disabled character, alternative long-term affects can be created. These can be things like injuries that will take time to heal, challenging emotional states, and changes to the character’s core beliefs. Additional detail and alternatives can be found in “Addressing Ableism: Sanity Systems.”



Derogatory language is frequently used for disability in games. This is particularly common when disability is being treated like a limitation. For example, physical disabilities have been called flaws, and mental illnesses have been talked about as madness, insanity, and derangements.

This derogatory language promotes negative stereotypes about disability and should be avoided. In some cases, simply shifting to neutral language will do what is needed. In other cases, the ableist language is connected to a stigmatizing idea that is being used in the game. For these situations, additional changes may be needed to remove this stigmatizing concept from the game. As an example, sanity systems are a type of mental hip point systems based on the stigmatizing and inaccurate concept of “insanity.” Language changes can be made to turn sanity systems into stress or fear systems. However sanity systems often involve giving characters mental illnesses as a result of failed rolls. As describe above, this can be changed by providing alternative consequences for failed rolls.


Customizing Characters

Because of the diversity of disabled experience, the best option is to handle all characters with disabilities individually. Whether that means custom-making the rules for a character’s disability or handling it entirely through role-play, this is about thinking through each character’s unique experience of disability and how to best represent that in the game. This allows us to consistently create respectful portrayals that are empowering and realistic representations of people with disabilities.


This is the third article in the Addressing Ableism in Tabletop Role-Playing Games series.


UPDATE: As of March 18, 2021, a significant update to this article is currently being carried out.


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[…] that I’ve read up on on breaks and between sessions that talk about disabilities and D&D. Addressing Ableism: Game Mechanics that Treat Disability as a Limitation is an excellent read on the ludonarrative dissonance that exists within the rules of D&D, that […]

2 years ago

Thank you for taking the time to write this series.

St. W.
St. W.
2 years ago

Some great points here, but I wanted to add some missing points about game design. I do have neurological differences that I perceive as largely beneficient, if sometimes inconvenient, and I have experience and some theory of making character creaton systems. While not using mechanics for a disability is a valid option, many do want the mechanical differences. That’s the way we interact with the game world. That’s why sleepyspoonie’s list exists, to give those traits substance. And I believe that rigorous enough rules would help players to understand the disability in question. I disagree with your point that basing… Read more »


[…] of disability that focus on limitation. While it is true that disability can create limitations, that isn’t the only way to experience disability, and many of the limitations experienced by disabled people are created by accessibility barriers. […]


[…] of being able to add advantages to some other aspect. There is a FANTASTIC series about this on It gives a lot of great insight AND examples of how to incorporate better systems into these […]

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