Prevalence, Predictors, and Treatment of Impostor Syndrome:
A Systematic Review

December, 18,  2019
Journal of General Internal Medicine [peer-reviewed]

Dena M. Bravata, MD, MS; Sharon A. Watts, MA; Autumn L. Keefer, PhD; Divya K. Madhusudhan, MPH; Katie T. Taylor, PhD; Dani M. Clark, BA; Ross S. Nelson, PsyD; Kevin O. Cokley, PhD.; Heather K. Hagg, PhD

Imposter syndrome describes high-achieving individuals who, despite their objective successes, fail to internalize their accomplishments and have persistent self-doubt and fear of being exposed as a fraud or imposter. People with imposter syndrome struggle with accurately attributing their performance to their actual competence and attribute setbacks as evidence of their professional inadequacy which may limit their ability to fully develop their professional potential.

Perhaps because it is not an officially recognized clinical diagnosis, despite the large peer-reviewed and lay articles—an abundance of non-peer reviewed literature, including 150-200 internet articles per month on social media platforms such as LinkedIn and Twitter—there has never been a published systematic review of the literature on imposter syndrome. The purpose of this study was to evaluate the prevalence of imposter syndrome in employed populations and characterize its relationship to workplace performance and burnout, characterize comorbidities, and determine effective treatments for those suffering from imposter symptoms.

Using reports of evaluations (62 studies, 14,161 participants) of the prevalence, predictors, comorbidities, or treatment of imposter syndrome, two independent investigators extracted data on study variables (e.g., study methodology, treatments provided); participant variables (e.g., demographics, professional setting); diagnostic tools used, outcome variables (e.g., workplace performance, reductions in co-morbid conditions); and pre-defined quality variables (e.g., human subjects approval, response rates reported). The included studies were all published between 1990 and 2018—notably, half were published in the past 6 years. Eleven included articles that evaluated impostor syndrome in minority groups, and 17 studies included populations with a mean age of > 30 years.

Our study is the first published synthesis of the peer-reviewed evidence on impostor syndrome. Our results suggest that impostor symptoms are prevalent among men and women and members of multiple ethnic groups, and are significantly associated with worsened experiences both in academic and professional settings. Employees who persistently question their professional legitimacy are at higher risk for experiencing adverse psychological outcomes with implications to career retention, advancement, and job performance and report less career planning and motivation to lead. The reviewed literature critically lacks thoughtful evaluations of treatments of impostor feelings. We encourage caregivers, professors, and employers to be mindful of the likelihood of impostor syndrome in the populations under their care and to take steps to mitigate these feelings.

Key Research Findings
Our study identifies documented feelings of inadequacy among men and women, in many professional settings, and among multiple ethnic and racial groups.
  • Men and women are equally disposed to impostor syndrome. However, women and men cope differently with their imposter feelings.

  • Age is not a predictor for imposter syndrome. There were no significant findings to suggest an age effect in professional environments.

  • Imposter syndrome is common among African American, Asian American, and Latino/a Americans.
None of the reviewed articles presented an evaluation of a specific treatment (e.g., cognitive behavioral therapy) for managing impostor symptoms. Additionally, there is considerable variation in how researchers interpret specific scores on the impostor syndrome diagnostic scales developed. Mental health professionals faced with patients suffering from impostor syndrome will likely use evidence-based treatments for comorbid conditions such as cognitive behavioral therapy or anxiety and depression, but do not have an evidence base upon which to rely specifically for the impostor symptoms.

Offering resources such as access to therapy and resilience training that focus on impostor syndrome could help reduce the prevalence of impostorism in employed populations. Given the tendency of people with impostor syndrome to aggressively pursue achievement while not being able to accept recognition when success is achieved, affected employees may experience increased levels of stress, burnout, and decreased job performance and satisfaction over time. Unfortunately, with the explosion of articles on imposter syndrome outside of academic literature, there is a vast amount of information that has no evidence base or clear plan for treatment and workplace prevention—add to that, imposter syndrome is not currently a recognized psychiatric disorder. Future research should include evaluations of treatments to mitigate imposter symptoms. Moreover, we recommend that imposter syndrome be considered for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM) so that the approach to patients with these symptoms can be codified for behavioral health providers. Finally, high-achieving professionals may be reluctant to participate in group therapy unless they are carefully designed to normalize and destigmatize impostor feelings and provide a safe environment in which to share experiences openly. Success-oriented employees commonly have a thirst for training and personal growth. In light of this evidence, we encourage professors and employers to incorporate recognition of this phenomenon in the development of both structured (e.g., training, orientation, onboarding) and unstructured (e.g., mentoring, coaching, self-directed learning) learning and career development activities.

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