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Prevalence, Predictors, and Treatment of Impostor Syndrome: a Systematic Review Dena M JGIM REVIEWS Prevalence, Predictors, and Treatment of Impostor Syndrome: a Systematic Review Dena M. Bravata, MD, MS1,2 , Sharon A. Watts, MA2,3,AutumnL.Keefer,PhD2, Divya K. Madhusudhan, MPH2, Katie T. Taylor, PhD2,3,DaniM.Clark,BA2,3, Ross S. Nelson, PsyD2,4,KevinO.Cokley,Ph.D.5, and Heather K. Hagg, PhD2 1Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA; 2Crossover Health, San Clemente, CA, USA; 3Untold Content, Cincinnati, OH, USA; 4Welleo Health, San Francisco, CA, USA; 5University of Texas at Austin, Austin, TX, USA. BACKGROUND: Impostor syndrome is increasingly pre- impostor feelings and common comorbidities. Future re- sented in the media and lay literature as a key behavioral search should include evaluations of treatments to miti- health condition impairing professional performance and gate impostor symptoms and its common comorbidities. contributing to burnout. However, there is no published KEY WORDS: review of the evidence to guide the diagnosis or treatment impostor syndrome; behavioral health; occupational health. of patients presenting with impostor syndrome. J Gen Intern Med 35(4):1252–75 PURPOSE: To evaluate the evidence on the prevalence, DOI: 10.1007/s11606-019-05364-1 predictors, comorbidities, and treatment of impostor © The Author(s) 2019 syndrome. DATA SOURCES: Medline, Embase, and PsycINFO (Jan- uary 1966 to May 2018) and bibliographies of retrieved articles. INTRODUCTION STUDY SELECTION: English-language reports of evalu- Impostor syndrome (also known as impostor phenomenon, ations of the prevalence, predictors, comorbidities, or fraud syndrome, perceived fraudulence, or impostor experi- treatment of impostor syndrome. DATA EXTRACTION: Two independent investigators ex- ence) describes high-achieving individuals who, despite their tracted data on study variables (e.g., study methodology, objective successes, fail to internalize their accomplishments treatments provided); participant variables (e.g., demo- and have persistent self-doubt and fear of being exposed as a graphics, professional setting); diagnostic tools used, out- fraud or impostor.1 People with impostor syndrome struggle come variables (e.g., workplace performance, reductions with accurately attributing their performance to their actual in comorbid conditions); and pre-defined quality variables competence (i.e., they attribute successes to external factors (e.g., human subjects approval, response rates reported). such as luck or receiving help from others and attribute set- DATA SYNTHESIS: In total, 62 studies of 14,161 partic- 2 ipants met the inclusion criteria (half were published in backs as evidence of their professional inadequacy). Psychol- the past 6 years). Prevalence rates of impostor syndrome ogists Clance and Imes first described impostor phenomenon 2 varied widely from 9 to 82% largely depending on the in 1978, and it came to widespread public attention after screening tool and cutoff used to assess symptoms and Clance’s 1985 book.3 Clance originally identified the syn- were particularly high among ethnic minority groups. Im- drome among high-achieving professional women, but more postor syndrome was common among both men and recent research has documented these feelings of inadequacy women and across a range of age groups (adolescents to among men and women, in many professional settings, and late-stage professionals). Impostor syndrome is often co- 4, 5 morbid with depression and anxiety and is associated among multiple ethnic and racial groups. with impaired job performance, job satisfaction, and Impostor syndrome is not a recognized psychiatric disorder: It burnout among various employee populations including is not featured in the American Psychiatric Association’sDiag- clinicians. No published studies evaluated treatments for nostic and Statistical Manual6 nor is it listed as a diagnosis in the this condition. International Classification of Diseases, Tenth Revision (ICD- LIMITATIONS: Studies were heterogeneous; publication 10).7 Outside the academic literature, impostor syndrome has bias may be present. become widely discussed, especially in the context of achieve- CONCLUSIONS: Clinicians and employers should be ment in the workplace. Perhaps because it is not an officially mindful of the prevalence of impostor syndrome among professional populations and take steps to assess for recognized clinical diagnosis, despite the large peer review and lay literature, although there has been a qualitative review,8 there Received July 29, 2019 has never been a published systematic review of the literature on Accepted September 12, 2019 impostor syndrome. Thus, clinicians lack evidence on the prev- Published online December 17, 2019 alence, comorbidities, and best practices for diagnosing and 1252 JGIM Bravata et al.: Impostor Syndrome: a Systematic Review 1253 treating impostor syndrome. Moreover, its actual effects on pro- Test” was also used), whereas Impostor Phenomenon was fessional performance and burnout both among healthcare pro- never used. We then used the content curation and analysis fessionals and others are not known. tool BuzzSumo to evaluate the number of Internet articles The purpose of this study was to critically evaluate the indexed with the term “Imposter Syndrome” published be- published literature on impostor syndrome—specifically to tween March 28, 2018, to March 28, 2019, and to measure the evaluate the prevalence of impostor syndrome in employed number of times these articles were shared, liked, or populations and characterize its relationship to workplace commented upon on social media platforms Facebook, performance and burnout, characterize common comorbidi- Pinterest, Reddit, and Twitter. ties, and determine the most effective treatments for popula- tions suffering from impostor symptoms. Data Synthesis and Analysis Given the heterogeneity of the included studies, we summa- rized the populations assessed, diagnostic tools used, and reported prevalence, comorbidities, and any treatments pro- METHODS vided qualitatively. The datasets generated during data collec- Data Sources and Searches tion and analysis are available from the corresponding author We developed search strategies for three databases: Medline, on reasonable request. Embase, and PsycINFO for citations dated January 1966 to May 2018. We used search terms such as Imposter Syndrome Role of Funding Source and Impostor Phenomenon (Appendix). We also reviewed bibli- This work was funded by Crossover Health, a provider of ographies of retrieved articles to obtain additional citations. employer-sponsored health clinics. The funder had no role in this study’s design, conduct, or reporting. Study Selection We considered peer-reviewed studies eligible for inclusion if they reported data on the prevalence, comorbidities, or treat- RESULTS ment of impostor syndrome. We excluded studies that were Our searches identified 284 titles of potentially relevant peer- only reported as dissertations, validations of scales to identify reviewed articles (Fig. 1). After synthesizing the data from impostor syndrome, described dementia- or delirium-based multiple reports on the same set of participants, 66 articles syndromes, or reported cases of legal fraud, impostor drugs, describing 62 studies with 14,161 participants met our inclu- Munchausen’s, or Munchausen’s by proxy. – sion criteria (Table 1).9 74] Data Extraction and Quality Assessment Study Characteristics Two authors independently abstracted five types of data from Although our searches were for the literature starting in 1966, each of the included studies onto pre-tested data collection the included studies were all published between 1990 and 2018 forms: study variables (e.g., purpose of the study, study meth- (Fig. 2)—notably, half were published in the past 6 years. odology, treatments provided); participant variables (e.g., de- Although most of the studies were conducted in the USA9, mographics, professional setting); diagnostic tools used to – – – – 10, 12, 13, 15 17, 21 32, 34 38, 42, 43, 45, 49 57, 61, 62, 64, 65, 67, 73 and assess for impostor symptoms, outcome variables (e.g., work- Canada,19, 44, 46, 66, 68 twenty-one studies evaluated popula- place performance, reductions in comorbid conditions); and – tions in other countries including five in Austria,39, 58 60, 63 pre-defined quality variables (e.g., human subjects approval, five in Australia/New Zealand,20, 31, 70, 71, 74 four in Germa- response rates reported). We resolved abstraction discrepan- ny,11, 14, 47, 48, 58 three in Iran,33, 40, 41 two in the UK,20, 69 and cies by repeated review and discussion. If two or more studies one each in Belgium72 and Korea.73 presented the same data from a single patient population, we Nearly all of the included studies were single-arm observa- included these data only once in our analyses. tional studies (Table 1). Most commonly, the authors identified a population of interest, screened them with a validated im- Lay Literature Search postor syndrome questionnaire and other psychometric assess- While performing background literature searches using gen- ment tools, then described the prevalence of impostor syn- eral Internet search engines, we noted an abundance of non- drome and co-occurring psychological issues. Two studies peer-reviewed literature on impostor syndrome. Thus, we also included semi-structured interviews.37, 38, 44 One study undertook a literature search to assess lay interest in the topic included an experimental design in
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