You might have heard about the Imposter syndrome (IS) on the internet Also known by imposter phenomenon, fraud syndrome, impostorism, or perceived fraudulence, this is a psychological experience where high-achieving individuals struggle to internalize their success. These people are clearly and objectively successful in real life and highly talented, however, if you ask them, they’ll tell you that they are nothing. They live in a state of persistent self-doubt. They seem to disount all or most of their achievements and are constantly worried about getting exposed as “frauds” (Bravata et al., 2020).
Origins and Evolution of Imposter Syndrome
First identified in 1978 by psychologists Dr. Suzanne Imes and Dr. Pauline Rose Clance, imposter syndrome was initially observed among successful women and marginalized groups (Bravata et al., 2020). Over time, research has shown that the imposter syndrome affects people across various industries and backgrounds, with a particularly high prevalence in academics and healthcare professionals.
Why High Achievers Are More Prone to Imposter Syndrome?
Studies indicate that individuals in competitive fields, such as medicine, are more likely to experience this syndrome. The struggle is not just limited to self-doubt, people with this syndrome also suffer from burnout, anxiety, and depression (Thomas & Bigatti, 2020).
What Causes Imposter Syndrome?
While imposter syndrome is widely recognized in psychological research, it has no formal classification in medical manuals like the DSM-5-TR. However, Clance’s original six characteristics of the this syndrome have been expanded upon over time. These key traits include:
- The Imposter Cycle
- Perfectionism
- Super-Heroism
- Atychiphobia (Fear of Failure)
- Denial of Competence
- Achievemephobia
(Mak et al., 2019; Bravata et al., 2020).
6 Key Traits of the Imposter Syndrome
1. The Imposter Cycle
At the core of imposter syndrome is the Imposter Cycle, a pattern that keeps individuals trapped in self-doubt. When faced with an important task, people with imposter syndrome tend to react in two ways:
- Over-Preparation: They believe they must work harder than others to achieve the same success. This overwork fuels their belief that they are only succeeding due to excessive effort, reinforcing their imposter feelings.
- Procrastination: Others delay tasks out of fear, leading to last-minute efforts. When they succeed, they attribute it to luck rather than skill, deepening their sense of fraudulence.
Regardless of their approach, any success feels fleeting, and they quickly return to feelings of anxiety, fear, and self-doubt—setting the stage for the next cycle (Jaremka et al., 2020).
2. Perfectionism
One of the most common traits of imposter syndrome is perfectionism, or the relentless need to be the best. Individuals with imposter syndrome set impossibly high standards, and when they fall short (as everyone inevitably does), they see it as proof of their inadequacy.
This perfectionism leads to:
- Work martyrdom – Sacrificing personal well-being for work.
- Overgeneralizing mistakes – Believing that small errors reflect a total lack of ability.
- Self-criticism – Engaging in harsh, non-constructive self-talk (Thomas & Bigatti, 2020).
3. Super-Heroism
Super-heroism is an extension of perfectionism. People with this syndrome feel they must overcompensate to appear competent. This leads to excessive workloads, burnout, and declining mental health. The constant need to prove their worth ultimately does more harm than good (Sukhera et al., 2022).
4. Atychiphobia (Fear of Failure)
Fear of failure is a major driver of imposter syndrome. Those with imposter syndrome experience intense anxiety over failing a task, believing failure will expose them as frauds. This fear isn’t just about personal disappointment—it’s about the perceived shame and humiliation that failure would bring (Giel et al., 2020).
5. Denial of Competence
Despite clear evidence of their abilities, individuals with imposter syndrome struggle to accept their own competence. They attribute success to external factors like luck or other people’s help rather than their own skills. This self-doubt prevents them from recognizing their true talents and achievements.
6. Achievemephobia (Fear of Success)
Oddly enough, fear of success is another hallmark of the imposter syndrome. People with imposter syndrome struggle to embrace their accomplishments because success often comes with increased expectations. They fear that more success means more pressure, making them anxious about maintaining high performance (Cavenar & Werman, 1981).
Who Is Most at Risk of Imposter Syndrome?
Research on the epidemiology of imposter syndrome remains limited, making it difficult to determine precise biostatistical data such as incidence, prevalence, and demographic breakdowns on a large scale. However, available studies suggest that imposter syndrome is disproportionately common in certain populations, particularly among women, marginalized groups, and individuals in high-pressure environments (Bravata et al., 2020).
Gender Differences:
- Imposter syndrome appears to be more common in females than in males.
- In a study of medical students, half of the female participants reported experiencing imposter syndrome, compared to just one-quarter of male students (Villwock et al., 2016).
Marginalized and Minority Groups:
- Racial and ethnic minority groups may experience imposter syndrome at higher rates, likely due to external societal pressures and systemic inequalities.
- Socioeconomic background can also play a role, with individuals from lower-income backgrounds feeling increased self-doubt in competitive academic and professional settings.
Students in High-Stakes Fields:
- Imposter syndrome is particularly prevalent among students in healthcare professions, including medical, dental, veterinary, pharmacy, and nursing students.
- A study on pharmacy students found that higher Clance Imposter Phenomenon Scale (CIPS) scores correlated with longer working hours and prior mental health treatment (Haney et al., 2018).
- Medical trainees, including residents and fellows, frequently report high levels of imposter syndrome, further linking it to burnout and psychological distress (Kogan et al., 2020).
Imposter Syndrome and Burnout
Imposter syndrome is not just an issue of self-perception—it has real consequences on mental health and well-being.
- The Maslach Burnout Inventory has shown a statistically significant association between IS and burnout in medical students (Villwock et al., 2016).
- The demanding nature of academic and professional environments, particularly in medicine, can exacerbate or uncover imposter syndrome in individuals who are already predisposed to self-doubt.
Symptoms of Imposter Syndrome
Cognitive and Emotional Symptoms:
- Imposter cycle (oscillating between over-preparation and procrastination)
- Intellectual self-doubt
- Low self-esteem
- Feelings of fraudulence and inadequacy
- Denial of competence and failure to internalize achievements
- Fear of success (Achievemephobia)
- Fear of failure (Atychiphobia)
- Super-heroism (overcompensating with excessive effort)
Associated Mental Health Conditions:
- Anxiety
- Depression
- Burnout
Professional and Social Context:
- Excessive comparison to peers (especially in high-stakes environments)
- Maladaptive personality traits (e.g., traits seen in perfectionism-driven personality disorders)
Evaluation and Diagnostic Tools
Since no formal external diagnostic criteria exist, identifying IS requires a holistic psychological and social evaluation.
Clinical Assessment Approach:
A thorough history and physical examination should focus on social, environmental, and psychological factors. Key areas to explore include:
- Work or academic pressures
- Self-perception of competence
- Responses to success and failure
- Burnout symptoms
- External validation needs
Commonly Used Diagnostic Scales:
- Clance Imposter Phenomenon Scale (CIPS) – Most widely used, consisting of 20 Likert-scale questions (Freeman et al., 2022).
- Harvey Impostor Phenomenon Scale
- Young Imposter Scale
- Leary Imposter Scale
- Perceived Fraudulence Scale
Though these tools help assess severity and characteristics, they lack external validation and should be used in conjunction with clinical judgment.
Informal Evaluations and Self-Assessment
Peer/Mentor Assessments:
- Individuals may recognize imposter syndrome traits in colleagues, students, or employees, prompting discussion and intervention.
Self-Reflection Exercises:
- Encouraging self-assessment through journaling, therapy, or online imposter syndrome screening tools may help increase self-awareness.
Treatment and Management
The approach to treating imposter syndrome depends on the individual’s level of distress and its impact on daily life. A tailored, case-by-case approach is necessary, especially when IS coexists with mental health conditions like anxiety, depression, or burnout.
Psychological and Behavioral Interventions
1. Self-Reflection and Metacognition
- Encouraging individuals to identify and challenge their thought patterns.
- Developing self-awareness about their cognitive distortions (e.g., minimizing achievements, attributing success to luck).
2. Counseling and Psychotherapy
- One-on-one or group therapy can provide emotional support and perspective.
- Peer support groups help normalize experiences and reduce self-isolation.
3. Cognitive Behavioral Therapy (CBT)
- CBT is the most evidence-based approach for this syndrome.
- Focuses on restructuring negative thought patterns and promoting self-compassion.
- Techniques include:
- Cognitive reframing (challenging irrational beliefs about success and failure).
- Behavioral experiments (testing assumptions through real-world experiences).
- Exposure therapy (gradually accepting praise and success).
Pharmacologic and Adjunctive Therapies
Pharmacotherapy (Case-by-Case Basis)
- No specific medications are approved for this.
- If IS coexists with anxiety, depression, or OCD, medications like:
- SSRIs/SNRIs (for anxiety and depression).
- Beta-blockers (for performance anxiety).
- Stimulants (if IS is linked to ADHD-related perfectionism).
- Future research may explore neurobiological interventions.
Gratitude and Mindfulness Practices
- Gratitude journaling shifts focus from perceived inadequacy to personal achievements.
- Mindfulness meditation reduces rumination and self-doubt.
- Positive affirmations help rewire self-perception.
Long-Term Management Strategies
Professional Development Interventions
- Mentorship programs to provide validation and support.
- Leadership training to build confidence in high-pressure careers.
Educational and Workplace Adjustments
- Institutions and workplaces can implement mental health initiatives to address this syndrome.
- Encouraging a growth mindset culture rather than a perfectionistic, high-pressure environment.
