This study investigates creep damage in laser powder-bed-fusion (LPBF) 316H stainless steel in the as-built (AB), stress-relieved (SR), solution-annealed (SA), and hot-isostatic-pressed (HIP) conditions, using X-ray computed tomography (XCT) as the primary technique, complemented by scanning electron microscopy (SEM). Creep tests were conducted at 725 °C and 100 MPa with loading parallel to the LPBF build direction, with wrought material used as a reference. Despite comparable failure time, significant variations in creep ductility are observed: low ductility for AB and SR, medium for SA and HIP, while high for the wrought material. XCT reveals that LPBF specimens exhibit enhanced crack growth and linkage. Creep failure in AB and SR is dominated by the development of one or two large macro-cracks exceeding 800 μm, whilst SA and HIP show a reduced size of 700 μm. In contrast, the wrought material fractures through the accumulation of numerous smaller cracks (<400 μm) with limited coalescence. Defect orientation analysis reveals damage in LPBF specimens is predominantly aligned at 45° to the load, with a secondary population perpendicular to it, whereas damage in the wrought material is primarily parallel to it. Alongside SEM fractography and longitudinal section observations, the low creep ductility in LPBF material can be attributed to the limited deformation capability, intrinsic to the dislocation cell structure, combined with creep damage governed by grain boundary decohesion and crack linkage across build layers. By contrast, the wrought material ruptures through ductile deformation and grain elongation, leading to creep damage aligned parallel to the loading axis.