By Aleksandra Gasparova MPH – Aleksandra is a third-year medical student with an interest in psychiatry and health behavior research. You can follow Aleksandra on LinkedIn and Facebook

How did I even get this far, I’m really not as smart as they think.. I just worked hard and got luck.
They’re going to know i’m an idiot, why would anyone trust me to take care of them?

..Will this feeling ever go away?

I would be lying if I said I didn’t have such thoughts at least a couple times a month. It was in graduate school that I discovered the term – “imposter syndrome,” and it’s an anxious pang that tells me i’m not good enough. 

In graduate school I was surrounded by individuals with several publications in peer-reviewed journals, taking a full coursework, working as teaching assistants and lab assistants, and  juggling internships while trying to pursue their own public health research. Despite all of the aforementioned, a common sentiment I would hear from my female colleagues was  “people think I’m competent – but I’m actually not, I don’t even know how I have this job.” This feeling of fraudulence is at the heart of imposter syndrome.

What is imposter syndrome?

 Imposter syndrome is a term first used by clinical psychologists Dr. Pauline Clance and Suzanne lmes in the 1970s.¹ It describes a pattern of behavior wherein people (even with external evidence of success) “doubt their abilities and have a persistent fear of being exposed as a fraud.” It is often found in competitive occupations and high-achieving environments such as academia, medicine, finance, and business.

With imposter syndrome you can have such thoughts and behaviors as¹:

• Failing to internalize your success (i.e. believing your success is due to luck, not character)
• Feelings of self-doubt, anxiety, and depression
• Being overly self-critical and feeling incompetent
• Sabotaging yourself
• Setting unrealistic expectations for yourself
• Overworking and overachieving

Unsurprisingly – when Drs. Clance and Imes first coined “imposter syndrome”, they were referring to high-achieving women (just like my female colleagues). The high-achievers observed by Drs. Clance and Imes reported  “feeling like a fraud”,  feeling as if they weren’t as intelligent as others, and would view their success as something that derived out of luck, not something driven by their character.²

According, to Drs. Clance and Imes described the “Imposter Phenomenon”  characterized by six factors that vary among individuals but can be damaging to one’s psychological well-being.²

1. the imposter cycle: This starts with an achievement related task (such as acing a difficult course) that is pursued through either over-preparation or procrastination. After the task is completed, any positive feedback for the “over-preparers” is attributed to hard work and for the “procrastinators” it’s seen as luck.²
2. the need to be the best: With imposter syndrome, one is a perfectionist, that tends to be surrounded by other high-achieving perfectionists. In consequence, “imposters” are more likely to diminish their own skills and talents as a defense mechanism, while also feeling inept if they are not the very best.²
3. superman/superwoman aspects: Similar to point 2, “imposters” are overachievers that set ambitious, sometimes unattainable goals. If and when these goals are not met, they are more likely to self-sabotage and avoid accepting additional responsibilities for fear of failure.²
4. fear of failure: The anxiety associated with achievement-related tasks is ultimately due to a fear of failure, and wanting to avoid feelings of shame.²
5. denial of competence and discounting: “imposters” will discount their own successes and attribute achievements to external factors.²
6. feeling fear and guilt about success: In some circumstances, “imposters” may feel isolated from friends and family and worry about being rejected for their perfectionist tendencies. In other ways, they may feel that they are not “good enough.”²

Though Drs. Clance and Imes studied high-achieving women, recent research In the 2019 Imposter Syndrome Study, has shown that both women and men have nearly equal rates of imposter syndrome.³ However, men were more likely to suppress these feelings while women were more likely to subconsciously act on them (i.e. self-sabotage).

 In 2021, this is especially problematic as these feelings of inadequacy contribute to the stubborn gender wage gap – women that feel less confident in their abilities are less likely to negotiate for the pay they deserve.³ Currently for every $1 earned by White men, women earn 0.10-0.46 cents less.⁴ This discrepancy is especially stark among women of color, with Hispanic or Latinx women earning 0.54 cents and Black women 0.62 cents for every $1 earned by White, non-Hispanic men.⁴  Aside from the economic impact, imposter syndrome can be harmful to mental health. Though it might not be found in the DSM-V (the diagnostic psychiatric manual), research has shown that the feelings associated with imposter syndrome, especially if prolonged, are found to be comorbid with depression and anxiety.²

How do you deal with imposter syndrome?

1. Acknowledge your feelings.⁶ If you can acknowledge these thoughts – you can work to reframe your perspective. Try to view them objectively and consider if these thoughts are helping or hindering your growth. Perfection does not exist, and constantly holding yourself to this standard can be counterproductive.
2. Speak to someone about how you’re feeling. It’s best to reach out to a close friend or family member – this can help you feel less isolated as well as validate your feelings.
3. Practice mindfulness. This can include meditation or writing in a gratitude journal. Such introspective practice can help gain self-awareness of your strengths and weaknesses, while helping you see that your value is not derived from external success. The more self-aware you are, the less likely you are to subconsciously limit your personal growth.
4. Find a mentor.⁶ Speaking with an experienced, trusted mentor that’s dealt with imposter syndrome themselves can help normalize your thoughts; they can also provide you with insight on how to cope with it.
5. If you feel that these thoughts are too intrusive –  if you’re feeling more anxious, down or depressed than usual, speak with a mental health professional that can provide you with additional resources.

So, does imposter syndrome get better? In the current infancy of my career, I’ve adapted a “fake it till you make it” mindset, but I do think there’s something to be said about a change in perspective.  One of my mentor’s, a former emergency medicine physician, once told me this – “Never in my life have I ever felt qualified for the job I have, but that is a good thing because it means I can continue to challenge myself and grow.”

 It may be that the ultimate way to cope with imposter syndrome is not seeing it as pathology, but embracing it as an indicator that one is making progress. I know that in the discomfort of fraudulent feelings, with mindful introspection I can embrace a mindset of growth and the knowledge that with time and experience, I’ll be “competent.”

References:

1. Clance PR, Imes SA. The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy (Chic). 1978;15(3):241-247.

2. Sakulku J. The imposter phenomenon. The Journal of Behavioral Science. 2011;6(1):75-97.

3. Watson C, Hoffman LR. Managers as negotiators: A test of power versus gender as predictors of feelings, behavior, and outcomes. The Leadership Quarterly. 1996 Mar 1;7(1):63-85.

4. Josa C. There’s a major part of the gender pay gap problem that no one is talking about. Independent. https://www.independent.co.uk/voices/gender-pay-gap-statistics-imposter-syndrome-fiona-bruce-equal-feminism-a8856886.html. Published April 5, 2019. Accessed March 9, 2021.

5. Quick facts about the gender wage gap. Americanprogress.org. Accessed March 2, 2021. https://www.americanprogress.org/issues/women/reports/2020/03/24/482141/quick-facts-gender-wage-gap/

6. Overcoming imposter syndrome. Apadivisions.org. Accessed March 2, 2021. https://www.apadivisions.org/division-28/publications/newsletters/psychopharmacology/2017/11/imposter-syndrome