Every so often there is a surge in articles in which well-known people talk about their experiences of imposter syndrome, also known as the imposter phenomenon. In the last few years we have heard from Taylor Swift,Jacinda Ardern, Tom Hanks, and ‘the pain of parental imposter syndrome’. The prevalence of the condition varies from 9 to 82% depending on the source, screening tool used, and population studied, with Forbes suggesting that 70% of Americans have the syndrome ‘at some point’.
There are several free online tests that promise to rate you on the ‘imposter syndrome scale’ while emphasising they are not diagnostic tools. I did one and found I have some signs of imposter syndrome, which wasn’t a surprise. I suspect this would be the case for most people clicking through, except perhaps for someone with an unusual level of self-confidence and swagger.
I have been interested in imposter syndrome since the beginning of my academic career in the mid 1990s, a time when professionalism and professional development were beginning to be included in medical curricula. The psychologists Clance and Imes first described the syndrome in 1978. From their psychotherapeutic perspective in relation to high-achieving women, they postulated that girls are socialised from an early age into thinking that their achievements are the result of luck or sympathy. By contrast, boys’ successes are put down to hard work or natural talent. Since then, however, imposter syndrome has been recognised to affect all genders.
It is interesting that an imposter is a person who pretends to be someone else for the purpose of deception and usually some sort of gain, for example monetary or power. Contemporary imposters are skilled at scamming and identity theft. The imposture act is deliberate whereas having imposter syndrome is a burden rather than a choice, the fraud is perceived but has no basis in reality, and there is no pleasure in the situation.
Imposture syndrome is a sign of identity insecurity. Professional identity formation is increasingly being recognised as a goal of health professional education. The possible role of imposter syndrome in hijacking a student or professional’s ability to develop a robust identity is being explored. But I must note that publications on the topic seem to be predominantly from highly developed countries, while the tools used for diagnosis do not appear to have been validated in non-white populations.5
A syndrome is a group of symptoms and signs that suggests a particular condition, typically thought of as abnormal – medical or psychological. Given that many of its symptoms occur so frequently, I feel we need to be careful of over-medicalising imposter syndrome. It is not yet recognised as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), which I feel is appropriate. The impact of symptoms varies as does the extent to which people can cope with the feelings of inadequacy, self-doubt and incompetence for which they have no external evidence. However, the syndrome can be associated with anxiety and depression and psychological support may be required.
I like this quote from a three-part blog on imposter syndrome from the Biophysical Society: ‘competence is not just about our ability to do the work, but also about our ability to convince others in the community that we can do the work well’. The authors emphasise the tension between personal and community identities: ‘who we are and who we are perceived to be’.8
This is important when we think about diversity and inclusion. Some must work harder to convince the community and their employers that they can do the work as well as more privileged groups. For example, if most senior doctors in a hospital are white and male, then these attributes may be seen as typical and put off those who do not have the same attributes from applying for certain positions or disadvantage them when they do.
Importantly, Tulyshan and Burey reflect on the tendency to put the blame for imposter syndrome on individuals, and note that ‘the impact of systemic racism, classism, xenophobia and other biases were categorically absent’ when Clance and Imes published their work. They advocate for fixing the places where women work, rather than fixing women at work.
Imposter syndrome – a much more complex and nuanced concept than I first imagined 25 years ago.
 Bravata DM, Watts SA, Keefer AL, Madhusudhan DK, Taylor KT, Clark DM, Nelson RS, Cokley KO, Hagg HK. Prevalence, Predictors, and Treatment of Impostor Syndrome: a Systematic Review. J Gen Intern Med. 2020;35(4):1252-1275. doi: 10.1007/s11606-019-05364-1.
 Clance PR, Imes SA. The imposter syndrome in high-achieving women. Psychotherapy: Treatment, research and practice 1982; 15: 241-247.