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Purpose of Review: Delusional misidentification syndromes (DMS) include conditions in which a false belief about the identity of a person, place, or object occurs in the context of psychiatric or neurological disorders. One form of DMS involves the delusion that the patient's mirror image is a separate individual. This review of reported cases characterizes the psychiatric, neuropathological, and neuropsychological aspects of DMS for the mirror image. An individual case presentation highlights the patient's subjective experience. Finally, the impact of this syndrome on the sense of self is considered., Recent Findings: Mirror DMS is a persistent delusion that occurs in the context of neurological illness. It is associated with right hemisphere impairment and a variety of neuropsychological and neuroimaging abnormalities. This phenomenon contributes to our understanding of a range of neurobehavioral syndromes that can be classified as neuropathologies of the self (NPS). DMS for the mirror image is a neurobehavioral syndrome in which the inability to recognize oneself in the mirror entails neurological, neuropsychological, as well as psychiatric aspects of the sense of self.