- Rare monsters can receive an monster prefix that gives the monster damage reflection, there is one prefix that reflects physical damage and another that reflects elemental damage.
- Some Map modifiers give all monsters in that map a damage reflection, either physical or elemental.
- Damage Reflection can be personally acquired by a Damage Return Item affix seen almost exclusively on Shields. Summoner type players that use Necromantic Aegis should consider using a Shield with a high amount of damage reflection for additional synergy as this effect spreads to all Minions.
The dangers of damage reflection
Reflection can be one of the most dangerous effects to encounter at high levels, especially for players focused on high damage output. A fast moving rare monster that appears quickly from off the screen can cause a large spike of damage to the player if hit by those high damage attacks or spells. Players must also be careful with skills that have a long duration (such assupported by and ), as once cast, they cannot be cancelled if a source of reflection appears.
Long-range attacks and spells can also be dangerous, as stray arrows and spells might hit a reflecting rare monster, causing a large amount of damage to the player.
Even monsters that are much lower level than the player and would normally pose no threat can prove deadly if affected by reflection, since the reflection is based on the player's damage output, not the monster's damage.
Reflection can sometimes be difficult to spot, especially in the heat of battle when the aura can be obscured by various skill effects, and other auras.
Dealing with reflection
- Reflected attacks can be blocked and dodged, and reflected spells can be blocked if the player has spell block or spell dodge. 
- Reflected damage is reduced by the attacker's Armour and resistances. For instance if a player with 75% lightning resistance deals 100 lightning damage to a monster with 20% elemental damage reflection, the player will only take 5 of the reflected 20 lightning damage.
- If the reflected damage is attack damage, it can be evaded. It uses your own accuracy rating. 
- Damage dealt by a player's totems, traps, mines, and minions will be reflected back to the totem/trap/mine/minion, not the player.
- A rare monster with a reflection aura can be converted, giving the player and the player's allies the benefits of the aura instead of the surrounding monsters.
- Having at least one skill that deals primarily physical damage can be useful for killing monsters with elemental damage reflection, and vice versa.
- Damage from degeneration effects such as burning is not reflected.
- Sufficient amounts of Life Leech can lessen or completely counteract the damage from reflection.
Reflect and Vaal Pact
Hit enemy -> Leech (Instantly) -> Reflect damage
- Mark_GGG (August 6, 2013). "Evasion and Damage Reflection questions". Path of Exile Forum. Retrieved November 17, 2015.
- Mark_GGG (April 23, 2013). "Mechanics thread". Path of Exile Forum. Retrieved March 25, 2013.
- Mark_GGG (July 14, 2014). "Possible to stun yourself on reflect with vulnerability?". Official Path of Exile Forum. Retrieved August 24, 2014.
- Mark_GGG (February 4, 2014). "I don't think I understand reflect". Path of Exile Forum. Retrieved August 24, 2014.
- Daniel_GGG (July 15, 2013). "0.11.2 Patch Notes". Path of Exile Forum. Retrieved October 20, 2013.
- Mark_GGG (July 15, 2013). "Phys Reflect VS Vaal Pact: who wins?". Path of Exile Forum. Retrieved November 17, 2015.