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

Impostor syndrome (also known as impostor phenomenon, fraud syndrome, perceived fraudulence, or impostor experience) 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 impostor.¹ People with impostor syndrome struggle with accurately attributing their performance to their actual competence (i.e., they attribute successes to external factors such as luck or receiving help from others and attribute setbacks as evidence of their professional inadequacy).² Psychologists Clance and Imes first described impostor phenomenon in 1978,² and it came to widespread public attention after Clance’s 1985 book.³ Clance originally identified the syndrome among high-achieving professional women, but more recent research has documented these feelings of inadequacy among men and women, in many professional settings, and among multiple ethnic and racial groups.^{4, 5}

Impostor syndrome is not a recognized psychiatric disorder: It is not featured in the American Psychiatric Association’s Diagnostic and Statistical Manual⁶ nor is it listed as a diagnosis in the International Classification of Diseases, Tenth Revision (ICD-10).⁷ Outside the academic literature, impostor syndrome has become widely discussed, especially in the context of achievement in the workplace. Perhaps because it is not an officially recognized clinical diagnosis, despite the large peer review and lay literature, although there has been a qualitative review,⁸ there has never been a published systematic review of the literature on impostor syndrome. Thus, clinicians lack evidence on the prevalence, comorbidities, and best practices for diagnosing and treating impostor syndrome. Moreover, its actual effects on professional performance and burnout both among healthcare professionals and others are not known.

The purpose of this study was to critically evaluate the published literature on impostor syndrome—specifically to evaluate the prevalence of impostor syndrome in employed populations and characterize its relationship to workplace performance and burnout, characterize common comorbidities, and determine the most effective treatments for populations suffering from impostor symptoms.

Our searches identified 284 titles of potentially relevant peer-reviewed articles (Fig. 1). After synthesizing the data from multiple reports on the same set of participants, 66 articles describing 62 studies with 14,161 participants met our inclusion criteria (Table 1).^9‐74]

This, the first published systematic review of the literature on impostor syndrome which includes a novel, if somewhat unconventional lay literature review, has six key findings. First, we found a large peer-reviewed literature of more than 60 studies, half of which were published in the last 6 years. This is congruent with the recent explosion in interest on the topic of impostor syndrome in the lay literature. There are several gaps between the peer-reviewed and lay literatures including that academics prefer the term Impostor Phenomenon while lay authors use Imposter Syndrome. Whereas the published literature included no studies of interventions to treat impostor syndrome, the lay literature abounds with advice on how to manage impostor symptoms.^{83, 84} Given the current state of the peer-reviewed literature, mental health professionals faced with patients suffering from impostor syndrome will likely use evidence-based treatments for comorbid conditions such as cognitive behavioral therapy for depression and anxiety, but do not have an evidence base upon which to rely specifically for the impostor symptoms. This is a critical gap in the published literature—we recommend a prospective evaluation of the use of individual and group cognitive behavioral therapy focused on addressing impostor feelings on clinical and workplace outcomes for employed populations across a range of professions. Moreover, we recommend that impostor 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.

Second, much of the earliest literature on impostor syndrome focused on women. While women do suffer from impostor syndrome, half of the included studies that reported evaluating a gender effect found no difference in the rates of men and women suffering from impostor syndrome. An implication of this finding is that clinicians and employers should be alert for impostor feelings in their entire population, not just women.

Third, numerous studies found impostor syndrome to be prevalent among ethnic minorities. A key finding from one of these studies is that impostor syndrome is a stronger predictor of mental health issues than minority status stress. This is particularly significant given that research on ethnic minority populations tends to focus on their minority status and presumed experiences of discrimination, rather than the individual differences within a minority group such as the impostor syndrome. Another important finding is that attempts to standardize impostor syndrome assessments typically include small numbers of ethnic minorities, which raises questions of whether current impostor measures are valid for ethnic minority populations.⁸⁵

Fourth, it would be reassuring to believe that impostor symptoms decline with age. Unfortunately, half of the six studies that reported on age effects found that impostor symptoms decline with age but half did not. Clearly, this is a key open question that future studies evaluating employed populations (rather than just evaluating students) could address.

Fifth, depression and anxiety are frequently comorbid with impostor feelings. In the absence of specific treatment recommendations for impostor syndrome, patients with impostor feelings should be rigorously screened for depression and anxiety and treated for these with evidence-based therapies. Individuals experiencing impostor syndrome often perceive themselves to be the “only one” having these feelings, resulting in even greater isolation.⁵³ Thus, referral to group therapy in which peers/coworkers discuss their feelings of doubt and failure might be particularly therapeutic. Clinicians and other high-achieving professionals may be reluctant to participate in such groups unless they are carefully designed to normalize and destigmatize impostor feelings and provide a safe environment in which to share experiences openly.

Finally, there is robust literature that describes the harmful association between impostor feelings and job performance, job satisfaction, and burnout among various employee populations, including healthcare professionals. 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. Success-oriented employees such as clinicians commonly have a thirst for training and personal growth. Offering resources such as access to therapy and resilience trainings that focus on impostor syndrome could help reduce the prevalence of impostorism in employed populations. When applicable, de-identified assessments can help the employees evaluate their personal change over time, while enabling managers to assess the impact of the structured intervention. In addition to structured and unstructured learning, professors and employers can target impostor syndrome by creating healthier expectations and a culture where mistakes are not interpreted as failures and publicly acknowledging and celebrating employee accomplishments.

Our study reflects the limitations of the included studies. First, nearly all studies were of the same design (cross-sectional surveys, often of convenience samples). The literature suffers from a lack of randomized and prospective trials and is likely subject to publication bias. Second, the weighted mean age of the studies that reported the age of their population was 20 years old, a finding driven by the preponderance of student populations among the included articles. However, given that 19 of the included studies described impostor syndrome in employed populations, the results of this review are relevant to older populations as well. Third, few studies addressed clinicians outside of academic environments—a critical gap given burnout among clinicians in a wide range of clinical settings. Additionally, the included studies evaluated workers only in a limited number of professional settings—none evaluated workers in technology companies—an important limitation given the amount of lay literature specifically targeting this population. Finally, given the nature of the reported data, we were precluded from performing quantitative synthesis of the included studies.

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. The 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.