According to legend, Narcissus upon gazing into a pond fell in love with his own reflection and it is from this tale that the psychological term “narcissism” is derived. Those who repeatedly study their image and are obsessed with themselves and in meeting their own needs without having concern for others are called “narcissists.”

The Diagnostic and Statistical Manual (considered the bible of mental health professionals) published by the American Psychiatric Association lists the criteria for Narcissistic Personality Disorder. In general one must exhibit a pervasive pattern of grandiosity in fantasy or behavior, a need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts as indicated by five or more of the following:

1. has a grandiose sense of self importance(e.g, exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love.
3. believes he or she is special and unique and can only be understood by or should associate with other special or high status people or institutions.
4. requires excessive admiration
5. has a sense of entitlement, i.e. unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
6. is interpersonally exploitative i.e. takes advantage of others to achieve his or her own ends
7. lacks empathy i.e. unwilling to recognize or identify with the feelings and needs of others
8. is envious of others or believes that others are envious of him or her.
9. shows arrogant, haughty behaviors or attitudes.

The above is the widely held view of Narcissistic Personality Disorder. Narcissists present difficulties to others and lead family members and associates to seek help in coping with them. Often the best strategy may be to set limits and/or to avoid the company of a narcissist. They are difficult to treat, demanding patients.

However, there are mirror-gazers who do not meet the above criteria. Because our society has placed an emphasis on feminine beauty, most non-narcissistic mirror gazers usually are women who do not have a grandiose sense of self-importance. On the contrary, they are usually self-contemptuous, and have poor self-esteem.

While it may be an asset to make a reasonable effort to look one’s best, for the mirror-gazer, no matter how hard she tries, she never feels she looks quite good enough. It may take her an inordinate amount of time to get ready before leaving home. She may annoy her friends or family by keeping them waiting. If her aim is approval from others, this behavior misses the mark.

Unlike the narcissist, her problem isn’t self-love, but self-loathing. She longs for the adoration from others, which she believes is totally dependent upon her having a perfectly beautiful appearance.

Such a woman may try to model herself in the image of those considered the most attractive, celebrated women of the time. Her self contempt leads her to a willingness to spend a large amount of time, money, inconvenience and even pain to achieve the image that she hopes will make her feel better about herself. In this pursuit, she may often endure painful and even risky cosmetic procedures. She may have her lips plumped, her bottom tightened, her breasts enhanced, her tummy tucked, eye-lids lifted and may even subject herself to repeated injections of substances that immobilize her facial muscles, all in the relentless cause of what is currently perceived as “beauty.” She is willing to accept the risks because she is overwhelmed by her need to be accepted, and the only way she believes she can achieve that goal stems from the erroneous notion that physical beauty is her most valuable attribute.

Before the problem intensifies, this type of behavior may be diminished using traditional psychotherapy. Otherwise, no matter how many cosmetic procedures the mirror-gazer undergoes, she may continue to feel that there is more she must do. Unsatisfied, she studies her image and finds fault. She is obsessed.

As she ages, her problem may grow worse. She can plainly read the ravages of time on her skin. She may become depressed. The only way out she sees to reach the same old goal, is to become a cosmetic procedure junkie.

Unfortunately, the basic problem mirror-gazers fail to realize is that true, everlasting beauty doesn’t come from the surface but from deep within. This kind of beauty withstands the test of time.

The contributions one makes to family, friends and society can bring the permanent hefty reward of self-esteem and self-acceptance rather than self-contempt. Learning this early in life and being able to withstand the influences of the mass media culture on young women is an important preventative.

We must educate as to what is truly important for a fulfilling life. Expressions such as “Handsome is what handsome does” must be emphasized. Making our heroes those who make a positive mark in society, those dedicated to making the world better for all living creatures would be far better than portraying the superficial, ubiquitous tabloid characters as worthy of high regard and overwhelming attention. Such a change would benefit mental health.

Dr. Ceren is a long time San Diego area psychologist specializing in relationships with self and others. To query: www.DrSandraLevyCeren.com