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With the exception of how they interact with damage resistances and vulnerabilities, damage types are often mechanically identical, offering no tactical difference between one another. Under this optional rule, before rolling damage after an attack, spell or ability, a player can instead opt to use the 'alternative effect' for that damage type based on the list below:

Acid

The corrosive spray of a black dragon’s breath and the dissolving enzymes secreted by a black pudding deal acid damage.

Consumed - Acid eats away at the target's defenses, reducing AC by -1 until they can repair the damage.

Bludgeoning

Blunt force attacks—hammers, falling, constriction, and the like—deal bludgeoning damage.

Pummeled - The attack overwhelms the creature, knocking it prone.

Cold

The infernal chill radiating from an ice devil’s spear and the frigid blast of a white dragon’s breath deal cold damage.

Frostbitten - Cold creeps into the creature's muscles and its movement is slowed by 10ft for until the end of its next turn.

Fire

Just as red dragons breathe fire, many spells conjure flames to deal fire damage.

Set Ablaze - The target catches fire and takes additional burning damage (1d6) at the start of the next turn unless it uses an action to put itself out. Flammable objects may also be destroyed.

Force

Force is pure magical energy focused into a damaging form. Most effects that deal force damage are spells, including magic missile and spiritual weapon.

Pushed - the target is pushed back 10ft by telekinetic energies.

Lightning

A lightning bolt spell and a blue dragon’s breath deal lightning damage.

Shocked - The target is shocked by the attack and can't take reactions until the end of its next turn.

Necrotic

Necrotic damage, dealt by certain undead and a spell such as chill touch, withers matter and even the soul.

Withered - The target is overcome with death and decay and can't regain hit points until the end of its next turn.

Piercing

Puncturing and impaling attacks, including spears and monsters’ bites, deal piercing damage.

Pinned - The attack pins the target, and it suffers disadvantage on dexterity saving throws until the end of its next turn or until the weapon is removed.

Poison

Venomous stings and the toxic gas of a green dragon’s breath deal poison damage.

Weakened - The attack strikes right at the vein, and must make their next poison save at a disadvantage.

Psychic

Mental abilities such as a mind flayer’s psionic blast deal psychic damage.

Dumbfounded - The target’s mind is overwhelmed and it has disadvantage on ability checks until the end of its next turn.

Radiant

Radiant damage, dealt by a cleric’s flame strike spell or an angel’s smiting weapon, sears the flesh like fire and overloads the spirit with power.

Dazzled - An intense flash temporarily blinds the target granting advantage on the next attack against them.

Slashing

Swords, axes, and monsters’ claws deal slashing damage.

Hamstrung - The attack at a tendon, rendering their next attack ineffective and at a disadvantage.

Thunder

A concussive burst of sound, such as the effect of the Thunderwave spell, deals thunder damage.

Disoriented - The sudden boom of sound throws the target off balance and deafens them until the end of their next turn.