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A heart attack instantly reduces a character HP to 0 and puts them on Death’s Door or kills them outright if they already have no HP. If stress continues to build for a character whose resolve has been tested and it reaches 200, they have a heart attack. This either gives them a flaw, like paranoid or hopeless, which will make them act on their own during battle to the detriment of the party, or make them virtuous, which gives them a positive characteristic, like heroic, that they can use to destress or buff their party members. When a character’s stress reaches 100, their resolve is tested. All characters have a stress gauge that goes from 0 to 200 and stress is inflicted by a multiple of sources: enemy attacks, curios, low torch light, and even walking backwards through a dungeon.
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The stress mechanic in Darkest Dungeon ties into the games Lovecraftian themes and portrays the deteriorating mental state of warriors as they encounter unknown horrors.
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