Imposter Phenomenon

Excerpt

Imposter syndrome (IS) is a behavioral health phenomenon described as self-doubt of intellect, skills, or accomplishments among high-achieving individuals. These individuals cannot internalize their success and subsequently experience pervasive feelings of self-doubt, anxiety, depression, and/or apprehension of being exposed as a fraud in their work, despite verifiable and objective evidence of their successfulness. The terms imposter syndrome and imposter phenomenon (IP) are used interchangeably, with IP gaining more frequent use in recent literature.

Imposter syndrome (also commonly-termed imposter phenomenon, fraud syndrome, impostorism, and perceived fraudulence) was first described in 1978 by Suzanne Imes, Ph.D., and Pauline Rose Clance, Ph.D. as an observation first among successful women and other marginalized groups.

In the interim, since the original publication by Clance Et. Al., imposter syndrome has expanded significantly in scientific literature and formal and informal media. The most commonly linked groups to imposter syndrome are typically comprised of high-achieving individuals and appear disproportionately prevalent in academics, particularly in the healthcare field. There is a particular interest in studying this phenomenon in medicine, as there is an established relationship between IS and other behavioral health disorders, including burnout, depression, anxiety, and exacerbation of other behavioral health issues.

While imposter syndrome is a commonly researched, experienced, and pervasive phenomenon, there is an unknown true prevalence. Currently, no formal or widely accepted medical definition exists (e.g., DSM-V criteria). Despite a lack of a formal definition, the original six criteria identified by Clance have been expanded upon since its inception and can be summarized as the following constellation of interrelated characteristics that may or may not be present in an individual with IS: the imposter cycle, perfectionism, super-heroism, atychiphobia (fear of failure), denial of competence, and achievemephobia.

I mposter Cycle

An essentially pathognomonic characteristic of imposter syndrome, the imposter cycle occurs when individuals with IS face an assignment, obstacle, duty, or other achievement-related tasks. In those with IS, the response to this achievement-related task is generalizable into two broad categories: over-preparation and procrastination.

In over-preparation, those with IS feel they must work harder than others to achieve the same goal, and because of this objectively false perception that one must put in more effort, they are an imposter. In cases of procrastination, those with IS feel that they are an imposter due to hurried 'last-minute' preparation and will eventually be exposed as a fraud.

Upon completion of the task, there is a brief sense of success or triumph in each scenario. Despite this sense of accomplishment, possibly due to one of the other five interrelated characteristics of IS (discussed below), the perceived brevity of the sense of success, or another poorly understood neurobiological mechanism of IS, there is a failure to internalize this sense of success. This leads to those with IS experiencing a spectrum of fear, anxiety, fraudulence, and other pathology leading into the next task, effectively repeating the aforementioned cycle.

Perfectionism

Perfectionism was originally described by Clance et al. as the 'need to be the best,' this category is a continuum of hyper-competitive and perfectionist behaviors that occurs when practically unattainable standards and goals are self-imposed by those with IS. These impossible-to-reach benchmarks continually drive a detrimental positive feedback loop in those needing to 'be the best.'

This aspect of IS can exacerbate phenomena such as work martyrdom (sacrifice of self-interests for a falsely perceived 'greater good'), over-generalizing mistakes that are perceived as a 'lack of ability,' and overly critical non-constructive self-feedback. These behaviors, among others, can lead to the super-heroism aspects of IS.

Super-H eroism

A commonly reported component of the imposter cycle, super-heroism is intrinsically related to the need to be the best. It often presents in IS as a tendency to over-prepare for tasks to appear more than capable of completing them. The central manifestation in this component of IS is over-preparation, which is secondary to the above-mentioned unattainable self-imposed standards. This additional workload is detrimental to mental health.

Atychiphobia (Fear of Failure)

Fear of failure manifests when facing externally or internally imposed achievement-related tasks. Individuals with IS experience anxiety, the fear of being shamed and /or humiliated if they fail or do worse than a peer on a particular task; thus, they are exposed as an imposter if they were to fail.

Denial of Competence and Capability

Closely tied to perfectionism, individuals with imposter syndrome tend to discount their intelligence, experience, skills, and natural talents. There is a propensity to internalize failure and relate success to external influence or random chance, despite evidence that the individual accomplished a particular task without these factors.

Achievemephobia (Fear of Success)

Describes the internalization of failures as a positive feedback loop and difficulty in internalizing or recognizing their successes, as succeeding may lead to higher expectations or increase pre-existing workload. These characteristics are not completely inclusive of all manifestations of IS, and the lack of any or all of these classically accepted characteristics does not exclude an individual from being affected by imposter syndrome.