Afflictions or Conditions in Fallout 4 are negative status effects that affect the player (Sole Survivor) as a result of various actions or interactions. These afflictions can arise from various sources, including environmental hazards, combat encounters, radiation exposure, or interactions with certain items. Players may accumulate multiple afflictions, temporarily impacting their Stats and S.P.E.C.I.A.L levels.


Fallout 4 Afflictions Guide

What are Afflictions in Fallout 4?

In Fallout 4, players can encounter a range of negative status effects that can hinder their character’s performance and well-being. These afflictions include radiation sickness from exposure to radiation, crippled limbs impairing mobility and combat capabilities, poisoning from toxins, addiction to different chems or alcohol, fatigue and sleep deprivation which affects overall effectiveness, and reduced radiation resistance against harmful radiation. Concussion, intoxication, and withdrawal also pose temporary afflictions, and managing these afflictions will require players to use remedies, rest, and remain cautious when exploring the vast wasteland.

What is Survival Mode in Fallout 4?

Survival Mode is an optional new mode that was added to Fallout 4 through a free update released on March 29, 2016. This update offers a more challenging and immersive experience for the players, making it harder to survive on the harsh wasteland. With this mode, new afflictions are added, and existing afflictions present from the base game are modified for this mode.


Addiction in Fallout 4

Addiction is an affliction acquired from repeated substance use. It represents a reliance on a substance, indicating that one's body or mind requires regular exposure to said substance to prevent withdrawal symptoms. Addictions can be viewed on the Stats page of the Pip-Boy by selecting Show Effects. On average, it takes around 3 repeated uses of a substance for a player to develop an addiction. The addiction withdrawal will impact the player's appearance, it can give them a slightly scrawny look, although this isn't noticeable if your character has a large or muscular body type. The Chem Resistant and Party Boy/Party Girl Perks can grant the player immunity to certain addictions.

Addiction can be cured by either visiting a doctor or consuming certain aid items such as:

  • Addictol: This is widely available from Medics or Merchants across the wasteland.
  • Radscorpion egg omelette: Can be crafted at a Cooking Station.
  • Refreshing beverage: Can be crafted at a Chemistry Station.
Addiction Effects Chance Source
Alcohol addiction 15-25% Alcoholic beverages
Buffout addiction 25-35% Buffout, Buffjet, Bufftats
Calmex addiction 35% Calmex, Calmex Silk
Daddy-O addiction 35% Daddy-O
Dark Craving Food can no longer satiate Hunger (But eating corpses can satiate hunger). Hunger sets in every 12 hours instead of 6, and the only possible states of Hunger are Satisfied and Ravenous. 100% Corpses
Day Tripper addiction 35% Day Tripper
Fury addiction 35% Fury
Jet addiction 25% Jet, Jet Fuel, Ultra jet
Med-X addiction
  • -1 AGI
  • -10 Damage Resistance
25% Med-X
Mentats addiction 10-25% Berry Mentats, Grape Mentats, Orange Mentats
Overdrive addiction 35% Overdrive
Psycho addiction
  • -1 STR
  • -10 Damage Resistance
25-35% Psycho, Psycho jet, Psychobuff
X-cell addiction
  • -1 S.P.E.C.I.A.L.
35%  X-cell

Withdrawal in Fallout 4

Withdrawal is an affliction that's directly related to Addiction. If the player becomes addicted to a certain substance, withdrawal will occur when the said substance is no longer in their system. The withdrawal will persist if not treated by either going to the doctor or consuming the substance that got the player addicted. During withdrawal, some stats will be lowered and these are often the ones that were increased under the influence of the substance that gave the addiction. Some perks like Chem Resistant affect these withdrawals.

Crippled Limbs in Fallout 4

In normal difficulties, crippled limbs in Fallout 4 will heal on their own after a certain duration but in Survival Mode, the player's legs can become crippled if they are over-encumbered. Crippled Limbs do not heal on their own during Survival Mode and must be healed by either using a Stimpak or by visiting a doctor. Having crippled legs will prevent the player from running and slows down overall movement including walking speed. If both legs are crippled, movement speed in third-person is noticeably slower than in first-person.

Encumbered in Fallout 4

Being Encumbered or Overencumbered in Fallout 4 means that the weight of the items in the player's inventory exceeds the maximum carry weight. When this happens, the player's character can no longer run, and the perk Sneak is affected. In survival mode, your character will also receive -2 points in Endurance and Agility, in addition to taking periodic damage. Your character can also no longer perform fast travel when this affliction is in effect.


Fallout 4 Survival Mode Afflictions Guide

Survival Mode in Fallout 4 is an unforgiving experience that punishes players in a multitude of ways, not just by increasing the difficulty, but by also completely changing the way players get to experience the harsh wasteland. In this mode, survival and simulation elements are added, meaning the player needs to watch over their Hunger, Thirst, and Sleep levels. They should also watch out for deadly diseases that can be inflicted upon their character. Failure to manage one's well-being will result in afflictions, ultimately reducing their maximum AP, and increasing the risk of contracting a disease.

Health and Vitality Factors

In Survival Mode, surviving in the wasteland demands proper self-care. You must stay hydrated, fed, and well-rested to remain combat-ready. Prolonged periods without food, water, or sleep will progressively affect your health, impacting your S.P.E.C.I.A.L. Stats, increasing Fatigue, weakening your immunity, and eventually causing physical damage to you. This will affect every decision you make because you will have to consider your overall and ever-changing health. The drive to survive may lead to unforeseen adventures, including encounters with dangerous wildlife while looking for valuable resources. Do note that not all consumables offer beneficial effects, and some of them may carry negative consequences, such as inducing thirst, hunger, fatigue, or even compromising your immunity, leaving you susceptible to illness.

Illness and antibiotics

The risk of illness can come from various sources such as food, drink, chem use, a creature's unarmed attack, and immersion in water or rain. All illnesses can be cured with antibiotics, by resting for several days, or by paying the Cure Health service from any doctor. The risk of contracting specific illnesses can be reduced by taking the appropriate herbal remedy. Do note that Stimpaks are no longer universally effective, so make sure you're always prepared. Any untreated illness usually persists for 2-7 days. See the table below for the list of diseases, their duration, and effects:

Disease Name Duration Effect
Fatigue 6 days Sleep timers progress more quickly. Require more sleep to avoid exhaustion debuffs.
Infection 3 days Continuously take bleed damage. Similar to poison. (Cannot reduce health below 1 HP).
Insomnia 2.5 days Sleep provides half as much tiredness reduction. +2 hours of sleep required to stay rested.
Lethargy 4 days -50% slower AP regeneration.
Parasites 7 days Food provides half as much hunger-reduction. Must eat x2 as much food to avoid hunger.
Weakness 2 days Take 20% more damage.

Stay hydrated

Thirst occurs if the player does not drink water (purified or dirty) for an extended duration. Thirst will slowly accumulate at all times, and having increased levels of thirst will modify your S.P.E.C.I.A.L. stats. Higher levels of thirst induce Fatigue, which affects your Action Points. Just like Hunger, damage will be taken, leading to a reduction in Hit Points. The majority of hydrating drinks will alleviate thirst to some extent, but specific drinks or soups are more effective than others. Do note that chems and healing aids are known to increase Thirst levels.

In Fallout 4, there are 6 stages of Thirst:

  • Hydrated: Perfect condition
  • Parched: -1 INT 
  • Thirsty: -2 INT, -1 PER 
  • Mildly Dehydrated: -4 INT, -3 PER, -1 LCK 
  • Dehydrated: -8 INT, -5 PER, -2 LCK 
  • Severely Dehydrated: -10 INT, -7 PER, -3 LCK + continuously take bleed damage. 

Just like in Hunger, the thresholds don't appear to be linear for the amount of time it gets from one stage to the other.

Healing takes longer

In Survival Mode, restorative items like Stimpaks and food will recover your health at a significantly slower rate. You'll need to time your healing precisely if you want to last.

Carry Weight and Encumbrance

In Survival Mode, your overall carrying capacity has been decreased, and now, items such as ammo and Stimpaks have weight value. Bullets and shells possess a minimal weight, which varies by caliber, while missiles and mini nukes are significantly heavier. Everything you choose to carry must be carefully selected, requiring you to prioritize power over volume when it comes to regulating ammunition.

Exceeding your carry weight reduces your overall Wellness, rapidly inducing fatigue, and may eventually result in crippled legs. Hoarding numerous items is no longer recommended, instead, opt to leave excess loot behind to prevent sustaining injury. You never know when you'll need to run from something in this dangerous wasteland.

Rest well

Fatigue primarily stems from exhaustion, but both hunger and thirst also affect it. Similar to radiation, fatigue impacts your Action Points instead of Hit Points. As fatigue increases, the availability of AP for actions such as sprinting and VATS diminishes. The amount of fatigue you've accumulated is indicated in red on your AP bar.

You are what you eat

Hunger occurs if the player does not intake any food for an extended duration. Hunger will slowly accumulate at all times, and having increased levels of hunger will modify your S.P.E.C.I.A.L. stats. Higher levels of hunger induce Fatigue, which affects your Action Points. Ultimately, damage will be taken, leading to a reduction in Hit Points. While most types of food alleviate hunger to some extent, certain foods are more effective than others.

In Fallout 4, there are 6 stages of Hunger:

  • Well-fed: Perfect condition
  • Peckish: -1 END 
  • Hungry: -2 END, -1 CHR 
  • Famished: -4 END, -3 CHR, -1 LCK 
  • Ravenous: -8 END, -5 CHR, -3 LCK 
  • Starving: -10 END, -5 CHR, -3, LCK + continuously take bleed damage. 

The thresholds don't appear to be linear for the amount of time it gets from one stage to the other. For example, it can take bout 6 hours to go from Well-fed to Peckish, to Hungry, then 12 hours from Hungry to Famished.

Choose your bed wisely

The type of bed you're sleeping in limits the length of time you are able to sleep, which in turn limits how much you can recover. Real beds, though rare, provide the most substantial benefits for resting, incentivizing you to work out of a home base or even spending the caps for a good night’s sleep. Make sure to take advantage of all the spots where you can use the Workshop to start building beds.

In Fallout 4, there are 6 stages of Exhaustion:

  • Well-rested: Perfect condition
  • Tired: -5% AP regeneration 
  • Overtired: -15%  AP regeneration, -1 STR 
  • Weary: -30% AP regeneration, -2 STR, -1 AGL, -1 LCK 
  • Exhausted: -50% AP regeneration, -4 STR, -2 AGL, -2 LCK + no sprint 
  • Incapacitated: -75$ AP regeneration, -6 STR, -4 AGL, -3 LCK + no running (can only walk)


Some consumables that remove radiation from your body come with the cost of inducing fatigue and temporarily damaging your immunity, leaving you more vulnerable to illness than usual. In Survival Mode, a negative effect is introduced to RadAway, to push players to use it only when necessary.

Crippled Limbs

In Survival Mode, having crippled limbs no longer recovers with time and must be healed by using a Stimpak, by sleeping it off, or by visiting a doctor for treatment. This not only makes combat encounters more difficult, but it also puts a further tax on Stimpaks. However, if you can acquire the third rank of Adamantium Skeleton perk, it will largely negate this effect as this perk completely eliminates any type of limb damage.


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