The heroic playstyle of 5e D&D is a lot of fun, but it’s focused on the encounter for resource management and pacing. Sometimes players want to break things up with more of a gritty or survivalist style. This means adding gameplay elements that focus on attrition, strategic resource management, mitigation, and lean into the fragile nature of health. In other words, it extends gameplay into longer term campaign elements, rather than containing it to individual encounters. As a result of Matt Colville’s recent twitch hangout, I was inspired to write down my own thoughts on gritty rules for 5e.

Important Side Note: Gritty play is sometimes pushed with a sense of elitism. This is a silly and as it’s just a style of play. Keep that in mind. If you choose this style of play, the game is inherently going to get much more about tracking and managing resources. There is nothing wrong if that style of play is not for you. However, if you enjoy it, these rules should give you something to sink your teeth into.

Don’t We Have This Already?

Discussion of gritty mechanics and survival rules in 5e is an evergreen topic. A quick google search will turn up a number grim dark, gritty, or other survival rules. However, I never thought these hit the right spot of focus or depth for my own campaigns. Even the 5e DMG has a set of Gritty Realism rules to use that just extends short rests to once a day, and long-rests to once a week. Rather than providing a different style of play, the gritty realism rules just make everything take longer. Therefore, they are neither gritty nor realistic.

What I’m presenting here is closer to the Slow Natural Healing rules in Chapter 9 of the DMG.

A Quick Note on Realism: A frequent mistake people make is to assume this is an attempt to make 5e more realistic or simulationist. It is not. This just makes mechanics about survival and health management more of a central gameplay element.

The Rules

A mixed party of six adventurers resting by the campfire deep in the woods.  Two appear to be wounded or exhausted.
Image credit Wizards of the Coast

Where noted these house rules replace the standard 5e rules.

Natural Healing

Short and Long Rest healing is no longer used, otherwise rests work as normal. Instead, players may only spend Hit Dice (HD) to heal at the end of a Long Rest. Also, HD are spent separately to heal ability scores, drain, and damage. Additionally players roll to recover spent Hit Die instead of recovering half of their HD at the end of a long rest. (You knew that was the rule right?) In this way, extended combat and stress have a larger impact and tend to grind characters down more.

The Long Rest sequence is as follows:

  • Roll to recover spent HD
  • Choose to spend HD on healing ability damage, drain, or to recovery hit points.
  • Modify any HD roll by the recovery conditions.

Recovering Spent HD

Hit Dice are recovered by rolling a DC 13 Constitution check for each spent HD at the end of a long rest, before any healing. Disadvantage may be imposed under harsh conditions, with inadequate shelter, or if unable to rest. Likewise advantage may be granted under good recovery conditions and medical care, such as at a sanctuary or house of healing.

Spending HD on Healing

Players choose to spend their HD to heal ability loss, drain, or damage separately as follows:

  • One Hit Die to recover one point of ability score loss.
  • One Hit Die roll to recover drain.
  • One Hit Die roll to heal damage.

Modifying Hit Die Rolls

Recovery assumes you have access to good shelter, food, sleep, and care. For each one of these conditions not met, the type of Hit Die rolled for recovery is reduced by one. This means 1d12 becomes 1d10, 1d10 a 1d8, and so forth down to a minimum of 1 point. See Chapter 5 in the DMG for more on conditions and survival.

Shelter: This assumes a restful and clean environment such as a private inn room or residence. In the wilderness this requires a DC 13 Wisdom (Survival) check with adequate supplies like tents, made with disadvantage setup or find a shelter with no equipment. A single character may make this roll for a group up to their skill bonus in size.

Good Food: A hot meal or good quality food is needed for healing. Characters can use the Foraging Rules from Chapter 5 of the DMG if they need to find food in the wilderness. Finding quality food with foraging is difficult. Roll twice when foraging and if both rolls are successful, the food is of high enough quality to satisfy this requirement. Otherwise it is simply enough to keep you from starving.

Sleep: Sleep or meditation is required as normal for your race. Without adequate shelter or if interrupted with combat this may require an individual DC 13 Constitution (Survival) check to satisfy this requirement. This roll may be modified or made at disadvantage under harsh conditions.

Medical Care: Having proper care is important for a speedy recovery. Characters proficient in the Medicine skill may make a DC 13 Wisdom (Medicine) check to provide proper medical care to themselves or others. The DC is increased by 2 for every patient over the first and is made at disadvantage without proper medical supplies.

Starvation and Water

As mentioned in the Good Food topic above, food is essential for survival and healing. Additionally, characters may suffer exhaustion from starvation or dehydration. The rules covering Food and Water in Chapter 8 of the PHB, and Foraging rules from Chapter 5 of the DMG, should cover this well. Games that need more harsh survival conditions can simply modify the DCs as appropriate.

Other Considerations

All-in-all a gritty playstyle will have extended rules over a number of sub-systems. These can be as expansive or brief as fits your campaign. However, I recommend starting with these gritty healing rules and see how they land with your players (after getting buy-in) and expanding from there if it seems fun. If so, you may also want to consider other expanded rules or modifications.

Limiting Hit Points: 5e does a better job of doing damage than most people give it credit for. However, there are various OSR rules for hit points you may want to consider if this is right for you. There is a different option that I think works better than limited hit points, that is limited healing. I will make a follow-up post about this later in the week but a complimentary rule is something that requires players to spend HD to receive healing, otherwise it heals 1 pt. This prevents turning the cleric into a heal-bot and more.

Infection & Disease: Using the disease rules from Chapter 8 of the DMG, you could decide to include infection from wounds in your game. I think this is for groups on the extreme end of gritty survival games but it’s a consideration. Use the rules for Sewer Plague to govern any infection.

Lowering Ability Scores: Many gritty games lean into randomly generated ability scores rather than having everyone in the group easily reaching maximum humanoid potential. So, choose a generation method that is right for you. Additionally, you may want to consider doing away with Ability Score Increases (ASI) and using Feats as the only option. This can add more variety and customization and some still come with a +1 ASI.

Spells: Gritty play puts more burden on spells and spell casters. Some DMs may consider banning or modifying spells like Goodberry, Create Water, Healing Spirit, and Tiny Hut.


Introducing a system like this significantly impacts the pacing of campaigns and challenge of encounters. This system works better for campaigns with modular encounters and opportunities to manage rest and recovery. Therefore, campaigns like Lost Mines of Phandelver, or Rime of the Frostmaiden may be better suited. Campaigns like Out of the Abyss or Tomb of Annihilation may require a lot of modification by the DM or be a poor fit for this style of play.

Watch for Part 2 of this series to address Gritty Healing and Spells, Potions, and Abilities later in the week.


Gritty rules aren’t for everyone, but can be a fun variation on your 5e play or suited for some groups playstyles. To be successful, you need full buy-in from everyone in the group and have to enjoy the management and level of detail that goes into this kind of play. Those that enjoy it can welcome the challenge of planning through recovery or mitigating for loss. DMs would do well to provide players both opportunities to shine, and interesting challenges to overcome through planning and preparation. To be sure, these rules are usually not for the faint of heart or play groups that don’t like getting lost in the details. Additionally, this playstyle is better suited for tier one and two play. However, most games happen in those tiers anyway and if you’re looking for higher tier play, gritty rules were probably never a consideration.

Now go out there and run some great games.