Prevalence, Predictors, and Treatment of ImpostorSyndrome: a Systematic ReviewDena M. Bravata, MD, MS1,2 , Sharon A. Watts, MA2,3, Autumn L. Keefer, PhD2,Divya K. Madhusudhan, MPH2, Katie T. Taylor, PhD2,3, Dani M. Clark, BA2,3,Ross S. Nelson, PsyD2,4, Kevin O. 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-sented in the media and lay literature as a key behavioralhealth condition impairing professional performance andcontributing to burnout. However, there is no publishedreview of the evidence to guide the diagnosis or treatmentof patients presenting with impostor syndrome.PURPOSE: To evaluate the evidence on the prevalence,predictors, comorbidities, and treatment of impostorsyndrome.DATA SOURCES: Medline, Embase, and PsycINFO (Jan-uary 1966 to May 2018) and bibliographies of retrievedarticles.STUDY SELECTION: English-language reports of evalu-ations of the prevalence, predictors, comorbidities, ortreatment of impostor syndrome.DATA EXTRACTION: Two independent investigators ex-tracted data on study variables (e.g., study methodology,treatments provided); participant variables (e.g., demo-graphics, professional setting); diagnostic tools used, out-come variables (e.g., workplace performance, reductionsin comorbid conditions); and pre-defined quality variables(e.g., human subjects approval, response rates reported).DATA SYNTHESIS: In total, 62 studies of 14,161 partic-ipants met the inclusion criteria (half were published inthe past 6 years). Prevalence rates of impostor syndromevaried widely from 9 to 82% largely depending on thescreening tool and cutoff used to assess symptoms andwere particularly high among ethnicminority groups. Im-postor syndrome was common among both men andwomen and across a range of age groups (adolescents tolate-stage professionals). Impostor syndrome is often co-morbid with depression and anxiety and is associatedwith impaired job performance, job satisfaction, andburnout among various employee populations includingclinicians. No published studies evaluated treatments forthis condition.LIMITATIONS: Studies were heterogeneous; publicationbias may be present.CONCLUSIONS: Clinicians and employers should bemindful of the prevalence of impostor syndrome amongprofessional populations and take steps to assess for
impostor feelings and common comorbidities. Future re-search should include evaluations of treatments to miti-gate impostor symptoms and its common comorbidities.
KEYWORDS: impostor syndrome; behavioral health; occupational health.
J Gen Intern Med
DOI: 10.1007/s11606-019-05364-1
© The Author(s) 2019
INTRODUCTION
Impostor syndrome (also known as impostor phenomenon,fraud syndrome, perceived fraudulence, or impostor experi-ence) describes high-achieving individuals who, despite theirobjective successes, fail to internalize their accomplishmentsand have persistent self-doubt and fear of being exposed as afraud or impostor.1 People with impostor syndrome strugglewith accurately attributing their performance to their actualcompetence (i.e., they attribute successes to external factorssuch as luck or receiving help from others and attribute set-backs as evidence of their professional inadequacy).2 Psychol-ogists Clance and Imes first described impostor phenomenonin 1978,2 and it came to widespread public attention afterClance’s 1985 book.3 Clance originally identified the syn-drome among high-achieving professional women, but morerecent research has documented these feelings of inadequacyamong men and women, in many professional settings, andamong multiple ethnic and racial groups.4, 5
Impostor syndrome is not a recognized psychiatric disorder: Itis not featured in the American Psychiatric Association’s Diag-nostic and Statistical Manual6 nor is it listed as a diagnosis in theInternational Classification of Diseases, Tenth Revision (ICD-10).7 Outside the academic literature, impostor syndrome hasbecome widely discussed, especially in the context of achieve-ment in the workplace. Perhaps because it is not an officiallyrecognized clinical diagnosis, despite the large peer review andlay literature, although there has been a qualitative review,8 therehas never been a published systematic review of the literature onimpostor syndrome. Thus, clinicians lack evidence on the prev-alence, comorbidities, and best practices for diagnosing and
Received July 29, 2019Accepted September 12, 2019
JGIM
1252
Published online December 17, 2019
REVIEWS
35(4):1252–75
treating impostor syndrome. Moreover, its actual effects on pro-fessional performance and burnout both among healthcare pro-fessionals and others are not known.The purpose of this study was to critically evaluate the
published literature on impostor syndrome—specifically toevaluate the prevalence of impostor syndrome in employedpopulations and characterize its relationship to workplaceperformance and burnout, characterize common comorbidi-ties, and determine the most effective treatments for popula-tions suffering from impostor symptoms.
METHODS
Data Sources and Searches
We developed search strategies for three databases: Medline,Embase, and PsycINFO for citations dated January 1966 toMay 2018. We used search terms such as Imposter Syndromeand Impostor Phenomenon (Appendix). We also reviewed bibli-ographies of retrieved articles to obtain additional citations.
Study Selection
We considered peer-reviewed studies eligible for inclusion ifthey reported data on the prevalence, comorbidities, or treat-ment of impostor syndrome. We excluded studies that wereonly reported as dissertations, validations of scales to identifyimpostor syndrome, described dementia- or delirium-basedsyndromes, or reported cases of legal fraud, impostor drugs,Munchausen’s, or Munchausen’s by proxy.
Data Extraction and Quality Assessment
Two authors independently abstracted five types of data fromeach of the included studies onto pre-tested data collectionforms: study variables (e.g., purpose of the study, study meth-odology, treatments provided); participant variables (e.g., de-mographics, professional setting); diagnostic tools used toassess for impostor symptoms, outcome variables (e.g., work-place performance, reductions in comorbid conditions); andpre-defined quality variables (e.g., human subjects approval,response rates reported). We resolved abstraction discrepan-cies by repeated review and discussion. If two or more studiespresented the same data from a single patient population, weincluded these data only once in our analyses.
Lay Literature Search
While performing background literature searches using gen-eral Internet search engines, we noted an abundance of non-peer-reviewed literature on impostor syndrome. Thus, weundertook a literature search to assess lay interest in the topicof impostor syndrome. We first used the search engine opti-mization tool Moz to evaluate the key terms used by authors ofInternet articles on impostor syndrome. The term ImposterSyndrome was almost exclusively used (“Imposter Syndrome
Test” was also used), whereas Impostor Phenomenon wasnever used. We then used the content curation and analysistool BuzzSumo to evaluate the number of Internet articlesindexed with the term “Imposter Syndrome” published be-tween March 28, 2018, to March 28, 2019, and to measure thenumber of times these articles were shared, liked, orcommented upon on social media platforms Facebook,Pinterest, Reddit, and Twitter.
Data Synthesis and Analysis
Given the heterogeneity of the included studies, we summa-rized the populations assessed, diagnostic tools used, andreported prevalence, comorbidities, and any treatments pro-vided qualitatively. The datasets generated during data collec-tion and analysis are available from the corresponding authoron reasonable request.
Role of Funding Source
This work was funded by Crossover Health, a provider ofemployer-sponsored health clinics. The funder had no role inthis study’s design, conduct, or reporting.
RESULTS
Our searches identified 284 titles of potentially relevant peer-reviewed articles (Fig. 1). After synthesizing the data frommultiple reports on the same set of participants, 66 articlesdescribing 62 studies with 14,161 participants met our inclu-sion criteria (Table 1).9–74]
Study Characteristics
Although our searches were for the literature starting in 1966,the included studies were all published between 1990 and 2018(Fig. 2)—notably, half were published in the past 6 years.Although most of the studies were conducted in the USA9,
10, 12, 13, 15–17, 21–32, 34–38, 42, 43, 45, 49–57, 61, 62, 64, 65, 67, 73 andCanada,19, 44, 46, 66, 68 twenty-one studies evaluated popula-tions in other countries including five in Austria,39, 58–60, 63
five in Australia/New Zealand,20, 31, 70, 71, 74 four in Germa-ny,11, 14, 47, 48, 58 three in Iran,33, 40, 41 two in the UK,20, 69 andone each in Belgium72 and Korea.73
Nearly all of the included studies were single-arm observa-tional studies (Table 1).Most commonly, the authors identifieda population of interest, screened them with a validated im-postor syndrome questionnaire and other psychometric assess-ment tools, then described the prevalence of impostor syn-drome and co-occurring psychological issues. Two studiesalso included semi-structured interviews.37, 38, 44 One studyincluded an experimental design in which subjects were ex-posed to successes and failures and asked to report on impos-tor feelings after these exposures.31 The only longitudinalassessment was of college students with impostor syndromewho were followed before and after a midterm examination.25
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1253
Notably, there were no randomized trials and only one studypresented qualitative information about the clinical manage-ment people with impostor syndrome.Overall, the quality of the included studies was fair: Only 20
studies reporting having Institutional Review Board (IRB)approval.10, 12, 13, 20–23, 28, 44, 46, 48, 50–52, 54, 58, 59, 62, 64, 66,73 Many studies lacking IRB approval were of studentpopulations—often in the authors’ own institutions. Responserates for the populations surveyed ranged from 2.8 to 97.2%(and many articles did not report response rates) (Table 1).
Participant Characteristics
The included studies evaluated 14,161 participants, 60% ofwhom were women. Among those studies reporting a meanpopulation age, the weighted mean age was 20 years (Fig.3)—not surprising given that 34 of the included studies wereof students. However, 17 studies included populations with amean age of > 30 years and 5 additional studies were ofprofessional populations but did not report a mean age.]–>
Students. Half of the included studies were of studentpopulations: 5 evaluated elementary and high-school stu-dents,16, 19, 27, 49, 61 29 evaluated undergraduates,10, 14, 20–25, 28, 30, 31, 35, 41–43, 45, 50–52, 55–58, 63–66, 68–70 and 12evaluated graduate students.17, 29, 31, 33, 34, 36, 39, 50, 55, 65,67, 73 Students with impostor syndrome had fears that weresignificantly related to maintaining their social standingand not wanting to display imperfection to others31; how-ever, social support and self-worth were highly negativelyassociated with impostor symptoms.16 Impostor feelingswere significantly related to pessimism, perfectionistic
traits, and low self-esteem, and although there were nodifferences in grades between impostors and non-impos-tors, impostors expected to perform worse and were moreanxious about exams.25 Interestingly, Ferrari found thatstudents with impostor feelings were significantly lesslikely to cheat on examinations and to plagiarize writtenassignments than students without impostor feelings.30
Students of Minority Groups. Eleven included articlesevaluated impostor syndrome in minority groups.10, 12, 13, 21–23, 29, 51, 52, 54, 64, 73 They demonstrated that impostor syndromeis common among African American, Asian American, andLatino/a American college students and that impostor feelingsare significantly negatively correlated with psychological well-being and positively correlated with depression and anxiety.21–23, 54 Several factors may predispose minority students toincreased psychological stress during their educational experi-ences including lack of adequate financial aid, the need to workto support themselves in school, racial discrimination, enduringnegative stereotypes, and being the first in their families topursue advanced education.21, 29 Moreover, using MANOVA,one study found that impostor feelings were stronger predictorsof mental health than minority status stress.21 Austin et al.found that impostor syndrome, depression, and survivor guiltwere highly correlated among African American college stu-dents.10 Bernard et al. found that African American freshmenwho reported frequent racial discrimination but low levels ofdistress from discrimination had higher levels of impostorsyndrome than those who reported high levels of distress fromracial discrimination.12, 13 Few non-White individuals havebeen included in the samples used to standardize the
Figure 1 Search results. Presents our search strategies and results.
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1254
Tab
le1.
Stud
yCha
racteristics
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
Ares,T.L.
(2018)(9)
USA
Evaluatetheprevalence
ofIS
inearlycareer
clinical
nursespecialists
Clin
ical
nurse
specialists(CNS)
68 RR-61.9%
94%
43%
was
30-39yrs
Cross
sectional
survey
Prevalence:74.6%.Prevalence
ofIP
was
notdifferentin
CNSs
who
wereem
ployed
vsthosewho
wereunem
ployed.IPwas
not
predictedon
thebasisof
perceived
preparedness
forCNSpractice,experiential
preparationforpractice,or
yearsof
leadership
experience.
Austin
etal.
(2009)
(10)
USA
Explore
themediatin
geffectsof
impostorism
ontheassociationbetween
survivor
guilt
anddepression
Black/African-
American
college
undergrads
97 RR-19.58%
72%
24yrs
Cross
sectional
survey
Prevalence:
Not
Stated.Survivorguilt
isa
significantpositiv
epredictorof
depression.
Participantswho
reported
greaterlevelsof
impostor
sufferingalso
reported
greater
degreesof
survivor
guilt
feelings.Im
postor
feelings
significantly
predicteddepression.
There
wereno
gender
differencesin
IP.
Bechtoldt
(2015)(11)
Germany
Analyzeshow
impostorism
affectsaspecific
component
ofleadership
behavior,which
istask
delegatio
n
Managersof
various
industries
190
RR–41.5%
35%
45yrs
Cross
sectional
survey
Prevalence:Not
Stated.The
morestrongly
managerslacked
confidence
intheirow
nabilitiesandperceivedthem
selves
asim
postors,themoreinclined
they
wereto
also
assign
challengingtasksto
theinsecure
maleandfemaleem
ployees.There
was
nosignificantassociationbetweenmanagers'
impostorism
andtheirdecisionson
delegatin
gthesetasksto
theself-confident
employees.
Bernard
etal.
(2017)(12)
(2018)(13)
USA
Examinetheassociation
betweenracial
discrimination
andtheim
postor
phenom
enon
African
American
college
students
157
RR–notstated
68%
Cohort
1-19yrs
Cohort
2-18yrs
Cross
sectional
survey
Prevalence:
Not
Stated.Wom
enreporting
high
frequencyof
racial
discriminationbut
lower
levelsof
distress
resulting
from
racial
discriminationhadhigher
levelsof
IP.
Brauer&
Proyer
(2017)(14)
Germany
Evaluatetheassociation
ofim
postor
phenom
enon
andpositiv
ecoping
skills
such
asplayfulness
Sample1–
Psychology
students
Sample2–
Working
professionals
Sample1-244
RR–notstated.
Sample2-222
RR–notstated
Sample
1-63%
Sample
2-63%
Sam
ple
1-23yrs
Sam
ple2
– 37yrs
Cross
sectional
survey
Prevalence:
Not
Stated.Amongboth
studentsandworking
professionals,
playfulness(anim
portantcharacteristic
ofresilience)
was
negativ
elycorrelated
with
IP.The
authorsreportmixed
correlations
betweendifferenttypesof
playfulness
amongstudentsandworking
professionals
with
andwith
outIP.Age
was
significantly
negativ
elycorrelated
with
IPam
ong
professionals(p<0.001)
butnotforstudents.
Byrnes&
Lester
(1995)(15)
USA
Assesslocusof
controlin
people
with
imposter
syndrome
Accountants
andteachers
60 RR–notstated
63%
38yrs
Cross
sectional
survey
Prevalence:
Not
Stated.Individuals
believing
morestrongly
inan
externallocus
ofcontrolweremorelik
elyto
feel
likean
imposter.
Caselman
etal.
(2005)(16)
USA
Evaluategender,global
self-
worth,social
support,andself-
conceptas
predictors
ofIP
amongadolescents
Highschool
juniors
andseniors
136
RR–notstated
52%
Not
Stated
Cross
sectional
survey
Prevalence:Not
Stated.S
ymptom
sof
IPare
foundam
ongadolescents.Globalself
worth,parent
support,classm
atesupport,
teachersupport,friend
support,sociability,
competenceanddependability
wereall
significantly
inverselycorrelated
with
IP(p<0.01).There
was
nogender
difference
inmeanIP
scores;however,thespecifictypes
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1255
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
ofsupportthat
weremostpredictiv
eof
IPforboys
andgirlsvaried.
Castro,
Jones
&Mirsalim
i,(2004)(17)
USA
Evaluatetheprevalence
ofim
poster
syndrome
amongindividuals
who
wereparentifiedas
child
ren
Psychology
graduate
students
213
RR–27.5%
85%
31yrs
Cross
sectional
survey
Prevalence:
80%
reported
atleastmoderate
levelsof
impostor
feelings
and30%
endorsed
significantim
postor
feelings;
MeanIP
score(Clance20
item
scale)
was
55.19.Fu
rther,C
aucasiansendorsed
moreIP
symptom
sthan
African
Americans.
Parentificationin
child
hood
was
highly
correlated
with
impostor
phenom
enon.
Chaeet
al.
(1995)(18)
Korea
Assesstheprevalence
ofIP
inKorea
Catholics
654
RR–notstated
49%
34yrs
Cross-sectio
nal
cohort
Prevalence:39%
usingacutoffof
58on
CIPSand24%
usingacutoffof
62on
CIPS;M
eanIP
score(Clance20
item
scale)
was
56.2
with
Standard
Deviatio
nof
9.7.
IPhigh
scorersareanxious,depressed,
emotionally
unstable,proneto
psychologicaldistress,andnegativ
eaffect.
Theytend
tobe
less
competent
andto
procrastinate,areeasily
discouraged,
and
tend
toavoidhard
work.
Interpersonalstyle
isglum
,detached,uncommunicative,aloof,
andskeptical.Theyareintrovertedand
suspicious
ofthemotives
ofothers.No
associationwith
gender
oreducation.
How
ever,youngerwom
enhadhigher
IPscores.)
Chayer&
Bouffard
(2010)(19)
Canada
Evaluatetheassociation
oftheuseof
social
comparisons
with
IP
5thand6th
gradestudents
740
RR–notstated
50%
10-12yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
score
(Likert-type
scale,ratedon
4-pointscale)
was
1.6.
There
was
nodifference
bygradeor
gender
inim
poster
feelings.20%
ofthestudents
didnotfeel
likeim
postorsat
all;80%
felt
likeim
postorsto
somedegree,and
3%said
they
felt"quite
like"
or"justlik
e"im
postors.Boysreported
ahigher
tendency
tousesocial
comparisonthan
girlsanda
greateruseof
downw
ardcontrastthan
girls.
Christensen
etal.
(2016)(20)
Australia,
New
Zealand,
UK
Examinetheprevalence
ofIS
infinalyear
nursing
students
Nursing
Students
223
RR-Aus
-23.9%
NZ–78.4%
UK
-86.6%
Not
Stated
Not
Stated
Cross
sectional
survey
Prevalence:45.1
%hadmoderateim
poster
phenom
enon,33.4%
wereclassified
asfrequently
having
imposter
feelings,and
8.3%
describedas
oftenexperiencing
intenseIS
experiences.
Apositiv
eweakcorrelationbetweenIP
and
preparedness
forpracticewas
found.
Cokleyet
al.
(2013)(21)
USA
Examinedifferences
relatedto
minority
stress
status,im
poster
feelings,andmental
health
inethnic
minority
students
College
students
240
RR-not
stated
62%
21yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
scores
(Clance20
item
scale,ratedon
5-point
scale)
wereAsian
Americans(A
MAs)
3.09
vsLatino/aAmericans(LAs)
2.80
vsAfrican
Americans(A
As)
was
2.56.
AAsreported
significantly
moregroup
stress,race-related
stress,and
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1256
Tab
le1.Stud
yCha
racteristics
Refere
nce
(Yea
rof publication)
Country
Stu
dyPurp
ose
Population
Sam
ple
Siz
e/
Resp
onse
Rate
(RR)
Gen
der
(%wom
en)
Age
(mea
n)
Stu
dyDes
ign
MainFindings
Ares,
T.L.
(2018)(9
)USA
Eva
luatethepreva
lence
ofIS
inea
rlyca
reer
clinical
nursesp
ecialis
ts
Clin
ical
nurse
specialis
ts(C
NS)
68
RR-61.9%
94%
43%
was
30-39yrs
Cross
sectional
survey
Preva
lence:74.6%.Preva
lence
ofIP
was
not
differen
tin
CNSs
who
were
employe
dvs
thos
ewho
were
unem
ploye
d.IP
was
not
predicted
onthe
bas
isof
perceived
prepared
nessforCNSpractice,
experiential
prepara
tion
for
pra
ctice,
orye
ars
ofleadersh
ipex
perience.
Austin
et
al.
(2009)(10)
USA
Exp
lore
themed
iating
effectsof
impos
torism
ontheas
sociationbetween
survivor
guilt
anddep
ression
Bla
ck/Afr
ican-
American
colle
geundergrad
s
97
RR
-19.58%
72%
24yrs
Cross
sectional
survey
Preva
lence:Not
Stated.Survivor
guilt
isasign
ifican
tpos
itive
predictor
ofdep
ression.Participan
tswho
reported
grea
ter
leve
lsof
impos
tor
suffering
also
reported
grea
ter
deg
rees
ofsu
rvivor
guilt
feelings
.Im
pos
torfeelings
sign
ifica
ntly
predicted
dep
ression.
Therewerenoge
nder
differen
cesin
IP.
Bechtoldt
(2015)(1
1)
German
yAnalyzes
how
impos
torism
affectsasp
ecific
compon
entof
lead
ersh
ipbeh
avior,
whichis
task
deleg
ation
Man
agersof
variou
sindustries
190
RR
–41.5%
35%
45yrs
Cross
sectional
survey
Preva
lence:Not
Stated.Themorestronglyman
agers
lack
edco
nfiden
cein
theirow
nab
ilities
andperceived
them
selves
asim
pos
tors,themoreinclined
they
were
toalso
assign
challengingtask
sto
theinsecu
remale
and
female
employe
es.There
was
no
sign
ificant
ass
ociation
betwee
nmanage
rs'im
pos
torism
and
theirdecisionson
deleg
atingthesetask
sto
theself-
confiden
tem
ploye
es.
Bernardet
al.
(2017)(1
2)
(2018)(1
3)
USA
Exa
minetheas
sociation
betweenracial
discrim
ination
andtheim
pos
torphen
omen
on
African
American
colle
gestuden
ts
157
RR
–not
stated
68%
Coh
ort
1-19yrs
Coh
ort
2-18yrs
Cross
sectional
survey
Pre
valence
:Not
Stated.
Women
reporting
high
freq
uen
cyof
racial
discrim
ination
butlower
levels
ofdistres
sresu
lting
from
racialdiscrim
ination
had
higher
levels
ofIP.
Brauer
&Proye
r(2017)(1
4)
German
yEva
luatetheas
sociation
ofim
pos
torphen
omen
onan
dpos
itiveco
pingsk
ills
such
asplayfulness
Sam
ple
1–
Psy
cholog
ystuden
tsSam
ple
2–
Working
professionals
Sam
ple
1-244
RR
–not
stated
.Sam
ple
2-222
RR–not
stated
Sam
ple
1-63%
Sam
ple
2-63%
Sam
ple
1-23yrs
Sam
ple
2– 37yrs
Cross
sectional
survey
Preva
lence:Not
Stated.Amon
gboth
studen
tsan
dworking
profess
ionals,playfulnes
s(an
important
charac
teristic
ofresilie
nce)was
neg
ativelyco
rrelated
with
IP.The
auth
ors
report
mixed
correlations
betwee
ndiffere
nt
types
of
playfu
lnes
samong
studen
tsand
work
ing
pro
fess
ionals
with
and
without
IP.
Age
was
significantly
negatively
correlated
withIP
amon
gprofessionals(p<0.001)but
not
forstuden
ts.
Byrnes
&Les
ter
(1995)(1
5)
USA
Assesslocu
sof
control
inpeo
ple
withim
pos
tersy
ndrome
Accou
ntants
andteac
hers
60
RR
–not
stated
63%
38yrs
Cross
sectional
survey
Preva
lence:Not
Stated.Individuals
believing
more
strongly
inan
extern
allocu
sof
control
were
more
likelyto
feel
likean
impos
ter.
Case
lman
etal.
(2005)(1
6)
USA
Eva
luate
gender,glob
alse
lf-w
orth
,so
cial
support,
and
self-con
ceptas
predictors
ofIP
amon
gad
olescents
Highschoo
ljuniors
andseniors
136
RR
–not
stated
52%
No
tStated
Cross
sectional
survey
Preva
lence:Not
Stated.Sym
ptoms
ofIP
are
found
among
adolesc
ents.
Global
self
worth,
pare
nt
support,
clas
smatesu
pport,
teac
her
support,
friend
support,
sociab
ility,co
mpeten
cean
ddep
endab
ility
were
all
sign
ificantly
inve
rsely
correlated
with
IP(p<0.01).Therewas
noge
nder
differen
cein
mea
nIP
scores;how
ever,the
specific
types
ofsu
pportthat
weremos
tpredictive
ofIP
forboy
san
dgirlsva
ried
.Cas
tro,
Jon
es&
Mirsa
limi,
(2004)(1
7)
USA
Eva
luatethepreva
lence
ofim
pos
tersy
ndrome
amon
gindividuals
whowereparen
tified
asch
ildren
Psy
cholog
ygrad
uatestuden
ts213
RR
–27.5%
85%
31yrs
Cross
sectional
survey
Preva
lence:80%
reported
atleas
tmod
eratelevels
ofim
postor
feelings
and
30%
endorsed
sign
ificant
impos
tor
feelings
;Mea
nIP
score
(Clance
20
item
scale)was
55.19.Further,C
auca
sians
endorsed
more
IPsympto
ms
than
African
Americans.
(con
tinued
onnex
tpage
)
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1257
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
environm
entalstress
than
LAsandASA
s.There
wereno
differencesby
gender
onIP.
ASA
sreported
significantly
higherim
poster
feelings
than
AAsor
LAs.There
wereno
differencesfoundin
IPby
AA
andLA.
Imposter
feelings
weresignificantly
positiv
elycorrelated
with
minority
status
stress
andnegativ
elycorrelated
with
psychologicalwellbeing.IP
was
astronger
predictorof
mentalhealth
than
minority
status
stress.
Cokleyet
al.
(2017)(22)
USA
Evaluatetheassociation
betweenim
poster
syndrome,perceived
discrimination,
andmental
health
amongminority
students.
College
students
322
RR–notstated
70%
21yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
scores
(Clance20
item
scale,ratedon
5-point
scale)
wereAsian
Americans(A
SAs)
3.19,
SD.64vs
Latino/aAmericans(LAs)
3.00,
SD.76vs
African
Americans(A
As)
2.99,
SD
.77.
AAsreported
higher
perceived
discriminationthan
ASA
sandLAs.There
wereno
differencesin
imposter
feelings
byracial/ethnicgroup.
AmongAAsandLAs
imposter
feelings
werenotpredictiv
eof
depression
butwereforanxiety.Among
ASA
s,im
poster
feelings
predictedboth
anxietyanddepression.
Cokleyet
al.
(2015)(23)
USA
Examinetherelatio
nshipof
gender
stigmaconsciousness,
impostor
phenom
enon
andacadem
icself-concept
African
American
College
students
491
RR–97.2%
70%
21yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
scores
(Clance20
item
scale,ratedon
5-point
scale)
weremalewas
2.94,SD
.69vs
female3.95,SD
.74.
IPwas
correlated
with
gender
stigma
consciousnessforboth
wom
enandmen.IP
andminority
stress
weresignificantly
negativ
elycorrelated
with
academ
icself-concept.There
was
noassociation
betweenIP
andgradepointaverage.
Cow
man
&Ferrari
(2002)(24)
USA
Evaluatetheassociation
ofself-reportedim
poster
tendencies
and
self-handicapping
tendencies
andsham
eandguilt
affect
College
students
436
RR–notstated
68%
Not
Stated
Cross
sectional
survey
Prevalence:
Not
Stated;Nogender
differencesin
meanIP
scores
(Clance20
item
scale,ratedon
5-pointscale).Mean
CIP
forgroup:
59.25(SD
13.86).Im
poster
tendencies
weresignificantly
predictedby
behavioral
self-handicapping,
sham
eand
guilt
affect
(p<0.05).
Cozzarelli
&Major
(1990)(25)
USA
Com
pare
the
psychological
responsesof
impostors
andnon-im
postorsto
amidterm
exam
College
students
137
RR–notstated
62%
Not
Stated
Prospective
cohort
study
Prevalence:
Not
Stated;MeanIP
score
(Clance20
item
scale)
was
65.71.
Students
weregivenquestio
nnairesat
3tim
esto
assess
pre-
vspost-mid-term
status.
Authors
used
themedianof
theCIP
scores
todistinguishim
postersfrom
non-
imposters.Im
postor
feelings
were
significantly
relatedto
pessim
ism
andself-
esteem
.Im
postersexpected
toperform
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1258
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
worse
andweremoreanxiousaboutthe
exam
than
non-im
posters,butactual
grades
didnotsignificantly
differ.Im
postorswere
significantly
morelik
elyto
make
attributions
tobadluck
andlow
ability
regardless
ofoutcom
ethan
werenon-
impostors.Im
postorsweresignificantly
less
satisfied
with
theirgrades
afterfailu
rethan
werenon-im
postors,buttherewereno
differencesbetweengroups
insatisfaction
aftersuccess.Im
postershadlower
post
exam
self-esteem
than
non-im
posters.
Crawford
etal.
(2016)(26)
USA
Examineassociation
betweentheIP
and
work-to-fam
ilyconflict
Employeesof
community
college
92 RR–25.27%
64%
47yrs
Cohortanalysis
with
3data
collection
intervals
Prevalence:
Not
Stated;MeanIP
score
(Clance20
item
scale)
was
2.57,SD
.62.
Emotionalexhaustio
nisamediatin
gmechanism
intherelatio
nshipbetweenthe
IPandWorkFamily
Conflict(W
FC).
PerceivedOrganizationalSu
pport(POS)
isamoderator
ofthisrelatio
nship.
When
employeesperceive
high
levelsof
POS,
the
relatio
nshipbetweenIP
andWFC
isminim
ized.
Cromwellet
al.
(1990)
(27)
USA
Toevaluate
theeffects
ofgender,grade,level,
GPA
,andpersonality
characteristicson
the
prevalence
ofIP
among
high
school
students
Englishhonors
students
ingrades
9-12
104
RR–18.4%
64.40%
Range:
14-18yrs
Cross
sectional
survey
Prevalence:20.9%
.Studentsweredivided
into
twogroups
basedon
IPscore(above
39=im
posters;under39
=non-im
posters).
Non-impostershadameanIP
scoreof
28.73,SD
.6.7andim
postershadameanIP
scoreof
45.7,SD
5.1.
Nostudentsscored
abovetheclinical
cutoffof
62.There
were
nodifferencesin
impostorism
bygender.
Imposter
feelings
wereassociated
with
perfectio
nism
andirratio
nalbeliefs.
Cusacket
al.
(2013)(28)
USA
Evaluatetheeffectsof
gender
andothervariables
onIP
College
students
506
RR–notstated
79%
21yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
Score
(Clance20
item
scale)
was
58.68,
SD13.87.
Wom
enweresignificantly
morelik
elyto
reportim
postor
beliefs
than
men.Mental
health,perfectio
nism
,andtestanxietywere
significantly
relatedto
impostor
beliefs,
whereas
low
self-esteem
was
notrelatedto
theIP.
Ewinget
al.
(1996)
(29)
USA
Explore
therelatio
nship
betweenracial
identity,
world
view
,graduate
school
environm
entandIP
African
American
Graduate
Students
103
RR–26%
70%
31yr
Cross
sectional
survey
Prevalence:
Not
stated.Standardmultip
leregression
analysisindicatedthat
amodel
thatincluded
BeliefSystemsAnalysisScale
andRacialIdentityAttitudesScale
scores
contributedto
significantproportio
nof
variance
inIP
scores
F(5,94)
=3.48.R2=
.16,
p≤.01.
Worldview
was
abetter
predictorof
susceptib
ility
totheim
poster
phenom
enon
than
racial
identityattitudes.
Whencombinedwith
academ
icself-
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1259
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
concept,racial
identityattitudes
significantly
contributedto
predictin
gim
poster
feelings.Authors
pointoutthat
imposter
syndromescales
have
notbeen
norm
edon
Non-W
hite
populatio
ns.
Ferrari,J.R.
(2005)(30)
USA
Explore
associationof
academ
icdishonesty
with
IP
College
students
124
RR–notstated
74%
21yrs
Cross
sectional
survey
Prevalence:
25.8%;MeanIP
score(Clance
20item
scale)
was
54.24,
SD13.27.
Studentswith
imposter
feelings
were
significantly
less
likelyto
cheaton
exam
inations
orto
plagiarize
inwritten
assignmentsthan
studentswith
outim
poster
feelings.
Ferrari&
Thompson
(2006)(31)
USA
Australia
Examined
impostor
fears,self-handicapping
andself-presentational
concerns
College
students
Study1–inUSA
Study2-in
Australia
Study1-
165
RR-not
stated
Study2–72
RR–notstated
Study1-
68.4%
Study2-
100%
Study1-
21yrs
Study2
-21yrs
Study1-Cross
sectional
Study2-
Experim
ental
Prevalence:
Not
stated;MeanIP
score
(Clance20
item
scale)
was
55.75,SD
13.97
and62.68,
SD
12.54in
Study1and2
respectiv
ely.In
Study1,
imposter
fears
weresignificantly
relatedto
social
desirability,perfectio
nistic
cognitions,and
non-displayof
imperfectio
nto
others.In
Study2,
wom
enwereexposedeither
toface-savingfailu
re(failure
that
didnot
indicate
low
ability,therebyassuagingself-
presentatio
nalconcerns),humiliatingfailu
re(w
here
nomitigatin
gexcuse
forpoor
performance
was
available),or
success.
Followinghumiliatingfailu
re,participants
high
inim
postor
fearsclaimed
more
handicapsthan
thoselow
inim
poster
fears.
How
ever,w
henprovided
with
aface-saving
excuse,theseparticipantgroups
didnot
differin
theirpropensity
toclaim
handicaps.
Fried-
Buschalter
(1997)(32)
USA
Investigategender
differencesin
fear
ofsuccess,fear
offailu
re,
andtheIP
Employees-
Marketin
gmanagers
104
RR–92.9%
49%
35yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
score(14
item
HarveyScale)was
43.16,
SD12.53.
Wom
enweresignificantly
(p<.05)
higher
than
themen
onfear
ofsuccess,butthere
wereno
significantgender
differenceson
fear
offailu
reor
theIP.A
mongboth
female
andmalemanagers,significantpositiv
ecorrelations
wereobserved
betweenfear
offailu
reandtheIP.
Ghorbanshirodi
(2012)(33)
Iran
Evaluatetherelatio
nship
betweenself-esteem,
emotionalintelligence,
andim
poster
feelings
Medical
students
200
RR–notstated
Not
stated
Not
stated
Cross
sectional
survey
Prevalence:
Not
Stated.Self-esteem
was
negativ
elycorrelated
with
imposter
syndrome(p=0.0001).One
aspect
ofem
otionalintelligence(utilizationof
emotion)
was
significantly
associated
with
imposter
syndrome.There
was
asignificant
gender
difference
intheassociationof
emotionalintelligenceandim
poster
symptom
s.Gibson-Beverly
&Schwartz
USA
Evaluatewhether
prior
parental
attachment
Female
graduate
students
170
RR–notstated
100%
34yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
score(20
item
ClanceScale)
was
54.37,
SD13.22.
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1260
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
(2008)(34)
andperceptio
nsof
entitlementarepredictors
ofIP
Anxious
attachmentandentitlementwere
positiv
elycorrelated
with
theClanceIP
Scale(p
<.01forboth).
Hayes
&Davis(1993)(35)
USA
Toinvestigatethe
relatio
nships
between
interpersonalflexibility,
Type
Abehavior,and
impostor
characteristics
Undergraduate
students
83 RR–notstated
71%
Men
–22yrs
Wom
en-
21yrs
Cross
sectional
survey
Prevalence:
Not
Stated.Interpersonal
flexibility
was
negativ
elyrelatedto
impostor
characteristicsforboth
men
and
wom
en.Ty
peA
andim
postor
characteristicswerenegativ
elyrelatedfor
men,they
werepositiv
elyrelatedfor
wom
en.The
results
oftheseanalyses
indicatedthat
themen
andwom
endidnot
differ
with
respectto
interpersonal
flexibility
(P>.08)
andTy
peA
characteristics(P
=.53).How
ever,wom
enhadsignificantly
higher
scores
onthe
impostor
test(P
<.02).
Henning
etal.
(1998)(36)
USA
Examinetheprevalence
andseverity
ofpsychologicaldistress
and
theIP
inhealth
profession
students
Graduatestudents
(in
health
professions)
477
RR–48%
53%
26yrs
Cross
sectional
survey
Prevalence:30.2%;MeanIP
scores
(Clance
20item
scale)
were57.83,
SD14.89for
wom
envs
52.08,SD
13.03formen.27%
ofmedical,dental,nursingandpharmacy
studentsreported
currentsymptom
sof
psychologicaldistress.30%
ofthestudents
hadIP
usingacutoffof
62on
theCIPS.
Significantly
morewom
enthan
men
met
criteriaforIP
(37.8%
vs.22%,P<0.001).
Psychologicaldistress
was
significantly
correlated
with
feelings
ofIP.
Hutchins&
Rainbolt
(2016)
(37)
Hutchinset
al.
(2018)(38)
USA
Evaluateem
otional
exhaustio
nandjob
satisfactionam
ong
faculty
with
IP
Academic
Faculty
Study1–16
Study2-310
RR–17%
63%
59%
Not
Stated
Cross-sectio
nal
survey
and
semi-structured
interview
Prevalence:
Not
Stated;MeanIP
score
(Clance20
item
Scale)was
2.81
and2.55
insample1andsample2respectiv
ely.IP
was
positiv
elyrelatedto
emotionalexhaustio
n(p
<.01)
andnegativ
elyrelatedto
job
satisfaction(p
<.01).Men
andwom
endiffer
intheircoping
strategies
tomanage
IP.
Jöstlet
al.
(2012)(39)
Austria
Evaluategender
differencesin
both
IPandresearch
self-efficacyof
doctoral
students
Graduatestudents
631
RR–notstated
62%
32yrs
Cross
sectional
survey
Prevalence:
82%
(atleastlow
levelsof
IP)
with
33%
ofthesamplereporting
symptom
sof
IPWom
enreported
higher
scores
ontheIP
Scale
andlower
levelsof
research
self-efficacythan
men.Wom
enhadgreater
fearof
successandfearof
failu
re,and
lower
self-esteem
than
men.Faculty
mem
bers
reported
higher
levelsof
both
theIP
and
research
self-efficacythan
non-faculty
mem
bers.
Kam
arzarrin
etal.
(2013)(40)
Iran
Evaluatetheassociation
betweenselfesteem
andim
posterism
Physicians
65 RR–notstated
46%
Not
Stated
Cross
sectional
survey
Prevalence:
Not
Stated.Selfesteem
isnegativ
elycorrelated
with
imposterism
(p=0.01).There
was
nodifference
inthe
associationof
selfesteem
andim
posterism
betweenmen
andwom
en.
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1261
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
Kananifar
etal.
(2015)(41)
Iran
Evaluatetherelatio
nships
betweenIP
andmentalhealth
Esfahan
university
Students
400
RR–notstated
Not
Stated
Not
Stated
Cross
sectional
survey
Prevalence:
Not
Stated.Theyfound
significantpositiv
ecorrelations
betweenIP
andsomatic
symptom
s,anxietyand
insomnia,social
dysfunctions,and
depression.
King&
Cooley
(1995)(42)
USA
Evaluationtheassociation
betweenIP
andfamily
achievem
entorientation
andachievem
ent-related
behaviors
College
students
127
RR–notstated
59%
19yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
scores
(Clance20
item
scale)
were59.47,
SD14.59wom
envs
53.40,
SD11.15men.No
gender
differencesin
family
achievem
ent
orientation,
butsignificantly
higher
CIPS
scores
amongfemales;A
positiv
ecorrelationwas
foundbetweenIP
and
family
achievem
entorientation.
Nosig
differencesin
gradepointaverageby
gender.Higherlevelsof
IPwerefound
amongfemales
with
IPbutnotformales.
Nogender
differencesin
numberof
hours
workedperweek.
Greater
numberof
hours
workedoutsidetheclassroom
onacadem
ics
was
significantly
correlated
with
IPfor
females,butnotformales.
Kum
ar&
Jagacinski
(2006)(43)
USA
Evaluatetherelatio
nship
betweenim
poster
fears
andachievem
entgoals
Psychology
undergraduate
students
135
RR–notstated
31%
19yrs
Cross
sectional
survey
Prevalence:
Not
Stated.Wom
enreported
greaterim
poster
fearsandwerehigher
inability-avoid
goalsthan
men.Among
wom
en,im
poster
fearsweresignificantly
associated
with
endorsem
entof
theentity
view
pointp<.001.For
both
men
and
wom
en,im
poster
fearswerepositiv
ely
relatedto
testanxietyandnegativ
elyrelated
toconfidence
inintelligence.
LaD
onna
etal.
(2018)(44)
Canada
Identifystrategies
tosupportphysicians
who
struggle
with
underperform
ance
Physicians
28 RR–2.8%
36%
Not
Stated
Qualitative
Study
(Sem
i-structured
Interviews)
Prevalence:
Not
Stated.Not
allparticipants
identifiedas
imposters;instead,
theauthors
consider
ISas
only
occurringattheextrem
eendof
thespectrum
ofself-doubt.During
residency,self-doubt
ismostly
around
apervasiveconcernthat
theirmedical
skills
andknow
ledgewerenotas
good
asthey
thoughtthey
were.For
consultants,their
insecuritiessuggestedafear
that
they
were
notas
good
asothers
thoughtthey
were.
Leary
etal.
(2000)(45)
USA
Study1:
Evaluatewhether
impostorsbelieve
others
perceive
them
morepositiv
ely
than
they
perceive
them
selves.
Study2:
Evaluatewhether
thecharacteristicsattributed
toim
postorsreflectinterpersonal
strategies
Study3:
Explore
whether
2types
ofim
postorsexist—
thosewho
believe
that
they
arenotas
good
Undergraduate
students
Study1:
238
Study2:
95Study3:
67RR–notstated
Study1:
50%
Study2:
49.47%
Study3:
Not
stated.
Study1
range:
17-23yrs.
Study2
and3:
Not
stated
Cross
sectional
survey
Prevalence:
Not
Stated.Study
1:Im
postorism
ismoreclearlyafunctio
nof
self-evaluations
than
ofthediscrepancy
betweenself-evaluations
andreflected
appraisals.
Study2:
Nosigdifference
inim
postorism
bygender.Highim
postorism
was
negativ
elycorrelated
with
expected
performance.Whenim
postorism
scores
weresplit
atthemedian,
high
impostors
respondedthat
they
would
score,on
the
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1262
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
asotherpeople
thinkand
thosewho
falselyclaim
that
others
have
overestim
ated
them
.
average,in
the66
thpercentilewhereas
low
impostorsindicatedthatthey
would
scorein
the75
thpercentile.Whenparticipants
thoughttheirresponseswerepublic,high
impostorsexpressedlower
expectations
regardingperformance,reported
that
doing
wellon
thetestwas
less
important,
derogatedthevalid
ityof
thetest,and
expressedless
satisfactionaboutthe
possibility
ofperformingwell.
Study3:
Impostorsindicatedthey
would
feel
less
good
aboutperformingwellwhen
theirscores
werepublic
rather
than
private.
Impostorism
was
negativ
elycorrelated
with
self-confidenceandselfesteem
.Legassieet
al.
(2008)(46)
Canada
Explore
theprevalence
andassociation
betweenim
postorism
andburnoutsyndrome
Internal
medicine
residents
48 RR–62.3%
52%
30yrs
Cross
sectional
survey
Prevalence:
43.8%;MeanIP
score(Clance
20item
scale)
was
61.2,14.2
SDIm
postorism
andburnoutsyndromewere
identifiedin
43.8%
and12.5%
ofresidents,
respectiv
ely.The
meanraw
scoreforCIPS
responseswas
61.2.Females
(p=.03)
and
foreignmedical
graduates(p=.03)
reported
significantly
higher
CIS
scores.A
significantnegativecorrelationwas
detected
betweenraw
scores
onthepersonal
accomplishm
entsubscale
andtheCIPS
(p=.04)
Leonhardt
etal.
(2017)(47)
and
Rohrm
annet
al(2016)(48)
Germany
Examinewhether
the
IPisahomogeneous
constructor
whether
differenttypesof
personswith
IPcanbe
distinguished
onthebasis
ofrelatedcharacteristics
Professionals
inleadership
positio
ns
242
RR–55.14%
37%
44yrs
Cross
sectional
survey
Prevalence:
Not
Stated.Persons
scoring
high
ontheCIPSweremorefrequently
employed
incivilservice
than
intheprivate
sector.Those
scoringhigh
onIP
couldbe
clusteredinto
twosubgroups:"true
imposters"
(who
displayedhigh
stress
and
strain,negativ
eself-evaluation,
procrastination,
andlargelynegativ
eem
otionalexperiences)
and"strategic
imposters"
(with
traitlevelsresembling
thosewith
outim
poster
self-concept).This
lattergrouparecharacterizedby
aform
ofdelib
erateself-presentation.
CIP
ishighly
positiv
elycorrelated
with
work-related
stress
andstrain,dysphoricmood,
anxiety
andishighly
negativ
elycorrelated
with
indicators
ofpositiv
eself-evaluation.
No
associationwas
foundbetweenim
poster
phenom
enon
andgender.
Lester&
Moderski
(1995)(49)
USA
Prevalence
ofIP
inhigh
school
students
Highschool
students
233
RR–notstated
41%
16yrs
Cross
sectional
survey
Prevalence:
Not
Stated.Correlatio
nsbetweenim
postorism
wereassociated
with
ahistoryof
priorsuicidal
ideatio
nand
attempts(p<.001)—
thiscorrelation
remainedsignificantafterbeingcontrolled
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1263
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
fordepression.Im
postorism
was
also
correlated
significantly
with
psychoticism,
neuroticism,irratio
nalthinking,andmanic
anddepressive
tendencies
(p<.05forall).
Age
andgender
werenotassociated
with
impostor
scores.
Liet
al.
(2014)(50)
USA
Evaluatetheassociation
ofcaring
andoverprotectiv
ebehaviorsof
parentsto
IPin
theirchild
ren
Undergraduate
andgraduate
college
students
506
RR–notstated
79%
21yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
score
(Clance20
item
scale)
formen
=54.57,
SD9.58
vswom
en=59.75,
SD14.61.
Wom
enreported
significantly
moreim
postor
feelings
than
men
(p<.001).For
wom
en,
parental
care
was
negativ
elyrelatedto
impostor
feelings
(p<.001)andparental
overprotectio
nwas
positiv
elyrelatedto
impostor
feelings
(p<.001).Fo
rmen,
neith
ercorrelations
weresignificant.
Ligeet
al(2017)(51)
andPeteet
etal.
(2015)(52)
USA
Evaluatetherelatio
nships
betweenracial
identity,
self-esteem,andIP
African
American
college
students
112
RR–notstated
74%
Not
Stated
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
score
(Clance20
item
scale)
was
54.48,SD
14.74
There
was
nosignificantcorrelation
betweenCIPSandgender,family
income,
classstanding,or
racial
identity.How
ever,
therewas
asignificantassociationbetween
IPandgradepointaverageandlow
self-esteem
Higherim
postorism
scores
were
foundto
predicthigher
psychological
distress
andlower
self-esteem.
Matthew
s&
Clance
(1985)(53)
USA
Presenttheexperience
ofpatientscaredforin
their
privatepractices
Professionals
41 RR–notstated
80%
Not
Stated
Descriptiv
ecohort
analysis
Prevalence:Not
Stated.The
foundno
gender
effect
intheprevalence
ofim
poster
syndrome(p=0.05).The
presenta
qualitativ
edescriptionof
theirexperience
inprivatepracticecaring
forpatientswith
imposter
feelings
andnote
theim
portance
ofvalid
atingpatients’
doubtsandfears,
directly
addressing
fearsof
failu
re,and
providinggrouptherapy.
McC
lain
etal.
(2016)(54)
USA
Evaluatetheassociationof
minority
stress
status,IP,
racial
centrality,andethnic
identityon
mentalhealth
amongAfrican
American
college
students
College
Undergraduates
218
RR–notstated
72%
21yrs
Cross
sectional
survey
Prevalence:
Not
Stated
Minority
stress
andIP
weresignificantly
negativ
elyrelatedto
mentalhealth
whereas
ethnic
identityandracial
centralitywere
positiv
elyrelatedto
mentalhealth.No
significantgender
differenceswerefound
McE
lwee
&Yurak
(2007)(55)
USA
Evaluatethedifferencesin
affect
andim
pression
managem
entstyles
betweennon-im
postors,
strategicim
postors,
andtrue
impostors
College
students
(undergrad
and
graduate
level)
Sam
pleA-124;
SampleB-125;
RR–notstated
SampleA:
84%.
SampleB:
64%
20yrs
Cross
sectional
survey
Prevalence:
Not
Stated.Im
postorism
isassociated
with
greaterlevelsof
negativ
eaffect
andlower
levelsof
self-esteem
and
positiv
eaffect.Im
postor
scores
werenot
predictedby
low
self-appraisalscombined
with
high
reflectedappraisals,butinstead
werepredictedonly
bylow
self-appraisals.
Impostorism
correlated
positiv
elywith
self-
handicapping
andnegativ
elywith
theself-
enhancingstrategies.Trueim
postorshad
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1264
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
lower
self-esteem
andmorenegativ
eaffect
than
didstrategicim
postors;however,they
didnotdiffer
onpositiv
eaffect.
McE
lwee
etal.
(2010)(56)
USA
Examineindividuals'
descriptions
ofIP
episodes
toidentify
theiraffectivecontent
andthesituational
andsocial
antecedents
College
undergrads
122
RR–notstated
74%
20yr
Cross
sectional
survey
Prevalence:Not
Stated.Qualitativeanalyses
yieldedem
ergent
them
esinthenarratives
ofstudentswith
impostorism
includingfear
ofexcessivefuture
expectations
andpositiv
eaffect
asaresultof
theperceiver's
view
.Quantitativ
eanalyses,foundthat
those
scoringhigher
onIP
scales
reported
more
fear/distressandguilt/shameduring
IPepisodes
butd
idnotd
ifferon
positiv
eaffect
noron
hostility,comparedto
thosescoring
relativ
elylow
ontheIP
scales.IP
scores
werepositiv
elyassociated
with
thedesire
tocorrecttheperceiver's
impression,both
atthetim
eof
theepisodeandat
thetim
eof
survey
completion.
McG
regoret
al.
(2008)(57)
USA
Examinetherelatio
nship
betweentheIP
and
depression
Liberal
Arts
college
students
186
RR–notstated
62%
Not
Stated
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
score
(Clance20
item
scale)
was
56.33,
SD=
11.59.
Wom
enhadhigher
IPscores
than
men
(p=.003).How
ever,therewas
nodifference
betweenmen
andwom
enon
theBeck
depression
Inventory.
IPwas
highly
correlated
with
depression
scores.
Neureiter&
Traut-M
attausch
(2016)(58)
Study1:
Austria
Study2:
Germany
Evaluatewhether
IPisa
potentialpsychological
barrierin
thecareer
developm
entprocess.
Study1:
College
undergrads
Study2:
Airport
employees
Study1:
212
Study2:
110
RR–notstated
Study1:
70%
Study2:
50%
Study1:
23yrs
Study2:
33yrs
Cross
sectional
survey
Prevalence:Not
Stated.Inboth
study1and
2:Im
postor
feelings
wereassociated
with
fear
offailu
re,fearof
success,andlowself-
esteem
.Participantswho
reported
more
impostor
feelings
reported
less
career
planning,less
career
striving,andless
motivationto
lead
Neureiter&
Traut-M
attausch
(2016)(59)
Austria
ExaminetheIP’sim
pact
oncareer
optim
ism,
career
adaptability,
know
ledgeof
the
jobmarket,em
ployee-
andorganizatio
nally
-relevant
outcom
es
Working
professionals
238
RR–66%
57%
Not
Stated
Cross
sectional
survey
Prevalence:N
otStated.P
eoplewith
IPhave
less
career
planning,jobsatisfaction,
and
organizatio
nalcitizenship
behavior
than
thosewith
outIP.The
authorsconclude
that
tocovertheirperceivedfraudulence,
impostersarelik
elyto
workhard
tofulfill
thedemands
ofin-rolebehavior
according
totheirow
nhigh
standards.Aspersonal
resourcesarerestricted,thiswill
resultin
less
extra-role
behaviors.
Neureiter&
Traut-M
attausch
(2017)(60)
Austria
Investigatehow
IPis
relatedto
career
planning
andoccupatio
nalself-efficacy
University
students
289
RR–notstated
75%
25yrs
Cross
sectional
survey
Prevalence:
Not
stated.IP
isnegativ
ely
correlated
with
planning,careerexploration,
andoccupatio
nalself-efficacy(p
<0.001).
Furtherm
ore,theIP
correlated
highly
significantly
with
three(concern,control,
confidence)of
thefour
dimensionsof
career
adaptabilityresources(ps<0.01).
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1265
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
Okoth
etal.
(1994)(61)
USA
Evaluatetheassociation
betweengeneralirratio
nal
thinking
andim
poster
feelings
in“disturbed”
adolescents
Adolescentsin
aFederalServices
day-care
program
21 RR–notstated
62%
15yrs
Com
parativ
eevaluatio
nPrevalence:
Not
stated.“D
isturbed”
adolescentshadhigher
impostor
scores
(p=0.01)butlower
irratio
nalityscores
(p=0.04)than
thenorm
alhigh
school
studentspresentedin
Lester&
Moderski.(49)Irratio
nalityandim
poster
scores
werecorrelated.
Oriel
etal.
(2004)(62)
USA
Evaluatetheprevalence
ofim
postor
feelings
infamily
medicineresidentsand
whether
impostor
scores
are
associated
with
anxietyand
depression.
Family
medicine
residents
185
RR–73%
52%
33yrs
Cross-sectio
nal
survey
Prevalence:
Men
–24%
vsWom
en–41%;
MeanIP
scores
(Clance20
item
scale)
were
54.3
men
vs58.5
wom
en,(p
0.03).There
wereno
gender
differencesin
self-esteem,
depression
orstateanxietyscores
but
wom
enhadhigher
traitanxiety(p
0.01).
Impostor
scores
werecorrelated
with
depressive
symptom
s(p<0.0001),with
trait
andstateanxiety(p<0.0001
forboth)but
notwith
yearsof
training,ageor
marital
status.Those
with
thehighestim
postor
scores
hadthelowestself-esteem
(p<0.0001).The
impostorsweremore
likelyto
worry
thatthey
will
notb
ereadyto
practiceaftergraduatio
n.In
multiv
ariate
analysis,whentraitanxietywas
controlled,
gender
nolonger
predictedim
postor
feelings
butdepression,traitanxietyand
self-esteem
remainedstatistically
significant.
Patzak
etal.
(2017)(63)
Austria
Examineself-com
passion
asapotentialresilience
factor
againsttheIP
College
students
459
RR–72%
69%
21yrs
Cross
sectional
survey
Prevalence:
9%Intenseim
poster
feelings,
31%
frequent
imposter
feelings,46%
moderateim
poster
feelingand14%
few
imposter
feelings.
Fenderandgender-roleorientationwas
both
statistically
associated
with
theIP.Male
studentssuffered
less
intenselyfrom
theIP
than
femalestudents;masculin
eand
androgynousstudentssuffered
less
intenselyfrom
theIP
than
feminine
students.Self-com
passionwas
negativ
ely
correlated
with
IP;with
increasing
intensity
ofIP,self-com
passiondecreases.
Self-com
passionwas
foundto
mediate
betweengender-roleorientationandtheIP.
Peteet
etal.
(2015)(64)
USA
Examinetheextent
towhich
1st-generatio
nstatus,psychological
well-being,
andethnic
identitypredictIP
scores
amonghigh-achieving
racial/m
inority
undergraduates
African
orHispanic
American
undergraduate
with
acollege
GPA
of>3.0
161
RR–14.6%
74%
Not
Stated
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
score
(Clance20
item
scale)
was
50SD
±14.78.
Resultsindicatedoverallmoderateim
postor
feelings/experiences
amongthesample.
Higherscores
ontheenvironm
entalm
astery
subscale
ofthewell-beingmeasure
andthe
affirm
ation/belongingsubscaleof
theethnic
identitymeasure
wereassociated
with
decreasedIP
scores. (c
ontin
ued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1266
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
Robinson
&Goodpaster
(1991)(65)
USA
Examinethedifferences
inIP
amongpersonswith
alcoholic
andnon-alcoholic
parents
College
&Graduate
students,
mem
bers
ofAdultChildrenof
Alcoholics
69 RR–notstated
Not
Stated
Range
–19-51yrs
Cross
sectional
survey
Prevalence:
Not
Stated.IP
was
highest
amongtheAdultChildrenof
Alcoholics
groupandlowestam
ongstudentswith
non-
alcoholic
parents.
Schubert&
Bow
ker
(2017)
(66)
Canada
ExaminetheIP
inrelatio
nto
self-esteem
College
undergrads
304
RR–notstated
75%
20yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
score
(Clance20
item
scale)
was
62.45,
SD=
13.10
Low
erself-esteem
was
associated
with
higher
impostor
scores.
Selby&
Mahoney
(2002)(67)
USA
Examinetheconsequences
ofself-focused
attention
amongself-described
impostersandnon-im
posters
who
exhibitedvarying
degreesof
complexity
intheirself-systems
Graduatestudents
5052%
28yrs
Experim
ental
analysis(pre-
post
aspecific
mirror
task)
Prevalence:40%;M
eanIP
score(Clance20
item
scale)
was
54.64,
SD12.20
Imposters’
galvanic
skin
responses(G
SR)
responsesduring
thecontrolcondition
(M=16.11,
SD=9.17)weresignificantly
lower
during
mirror2condition
(19)=2.99,p=.008,but
notdifferentfrom
theirresponsesduring
mirror1condition,
t(19)=.065,p=.52).Likew
ise,theirGSR
responsesduring
mirror1condition
were
substantially
lower
than
during
themirror2
condition
t(19)=5.23,p<.001.Im
postersand
Non
impostersdidnotdiffer
inaverage
GSR
responsesduring
theMirror2
condition,t(48)=
-.97,p=.397.How
ever,
impostersdidreportsignificantly
lower
self
esteem
scores
aftertheexperimental
condition
than
non-im
posterst(48)=
-4.94,p<
.001
Septem
beret
al.
(2001)(68)
Canada
Relatewell-beingto
IPand
gender
role
orientation
College
students
379
RR–23%
68%
22yrs
Cross
Sectional
survey
Prevalence:
Not
Stated.There
wereno
differencesin
IPby
gender
orgradepoint
averageas
measuredby
CIPSwith
athresholdof
62.HighIPsscored
lower
inwell-beingandself-acceptance.Sig
differenceswerefoundin
IPby
gender
role
orientation.
Sonnak
&To
well(2001)
(69)
UK
Investigatetherole
ofperceived
parental
rearingstyle,parental
background,self-esteem,mental
health
anddemographicvariables
upon
IPintensity
College
students
107
RR–notstated
73%
26yrs
Cross
sectional
survey
Prevalence:43%;M
eanIP
score(Clance20
item
scale)
was
70.59,
SD6.16.
Bothgreaterdegree
ofperceivedparental
controland
lowerlevelsof
self-esteem
were
significantpredictors
ofim
postor
fears.
Parentalcare
score,parental
educational
andoccupatio
nallevelandsubject's
mental
health
anddemographicinform
ationdidnot
show
asignificantrelatio
nshipto
impostor
scores.A
post-hoc
regression
analysis
indicated,
however,that
inadditio
nto
parental
protectio
n,lower
care
andpoorer
mentalhealth
was
significantly
relatedto
increasing
levelsof
impostor
scores
and
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1267
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
with
subjectshaving
attended
privateschool
reportinglower
levelsof
impostor
feelings.
Inadditio
n,subjectsclassified
asim
postors
werefoundto
reportsignificantly
higher
GHQ
scores
(poorermentalhealth)than
non-im
postors.
Thompson
(1998)(70)
Australia
Clarify
theaffective
andattributional
behavior
ofim
postors
follo
wingsuccess
andfailu
refeedback
College
students
(Psychology)
164
RR–65%
77%
20yrs
Cross
sectional
survey
Prevalence:
48.8%;MeanIP
score(Clance
20item
scale)
was
73.05,
SD6.68.
Using
the62-cutoffscore,48.8%
ofrespondentswereclassified
asim
postors
with
51.2%
classified
anon-im
postor
onCIPS.W
hileahigher
percentage
offemales
(50.8%
)relativ
eto
males
(39%
)were
classified
asim
postors,thisdifference
did
notreachstatistical
significance.Age
was
negativ
elyassociated
with
impostor
fears.
Impostersfeltgreaterhumiliationandguilt
afterfailu
rethan
success;therewas
nosig
difference
inthesein
either
the
success/failu
recondition
fornon-im
posters.
Impostersattributed
poor
performance
tointernal
factorsto
agreaterextent
than
non-im
posters.Im
postersreported
lower
academ
icandglobal
self-esteem
than
non-im
posters.There
was
nodifference
inGPA
betweenim
postersandnon-im
posters.
Thompson
(2000)(71)
Australia
Toassess
theconnectio
nbetweenim
postor
fears
andperfectio
nistic
concernover
mistakes
College
students
(Psychology)
60 RR–not
stated
82%
21yrs
Cross
sectional
survey
Prevalence:
Not
assessed
inthisstudy.
Impostersreported
less
control(p
<0.005),
greateranxiety
(p<0.002),morenegativ
eaffectandgreaterconcernover
mistakes(p
<0.01),than
non-im
posterswhen
performingtasks.
Vergauw
e(2015)(72)
Belgium
Examinethetrait-relatedness
oftheIP
andthepotentialim
pact
ofIP
onrelevant
workattitudes
andorganizatio
nalcitizenship
behavior
White
collar
workers
201
RR–not
stated
58%
36yrs
Cross-sectio
nal
survey
Prevalence:20%;M
eanIP
score(Clance16
item
scale)
was
57.93,
SD6.96.
Nosignificantsexdifferencesin
mean
impostor
tendencies.Im
postor
tendencies
arepositiv
elyrelatedto
neuroticism,
maladaptiv
eperfectio
nism
andnegativ
elyto
conscientio
usness
andadaptiv
eperfectio
nism
.Nosignificantrelatio
nships
wereobserved
betweenim
postor
tendencies
andopenness
oragreeableness.
Significantmoderationeffectson
were
foundin
thepresentstudyforjob
satisfactionandorganizatio
nalcitizenship
behavior.
Villwocket
al.
(2016)(73)
USA
Toassess
gender
and
otherdemographics
associated
with
IPand
evaluate
weather
IPisassociated
with
burnout
Medical
Students
138
RR–5.28%
56%
18-24yrs
- 43%,
Cross
sectional
survey
Prevalence:49%
offemales
and23.7%
ofmales
displayedIS
(Young
Imposter
Scale).
WhiteandAsian
race/ethnicity
isassociated
with
lower
ratesof
IS(30%
)comparedwith
otherraces(73%
).Femalegender
was
not
(con
tinued
onnex
tpa
ge)
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1268
Table
1.(con
tinue
d)
Reference
(Year
of publication)
Cou
ntry
Stud
yPurpo
sePop
ulation
SampleSize/
Respo
nseRate
(RR)
Gender
(%wom
en)
Age
(mean)
Stud
yDesign
MainFinding
s
25-30yrs
- 50%
significantly
associated
with
burnout.
Studentswith
IShadincreasedlevelsof
exhaustion,
emotionalexhaustio
n,cynicism
,anddepersonalization.
Fourth
year
studentshadhigher
levelof
ISthan
otheryears.
Want&
Kleitm
an(2006)
(74)
Australia
Toexam
ineparental
rearing
styles
andobjectiveconfidence
inrelatio
nto
impostor
phenom
enon
andself-
handicapping
tendencies
Mixed
occupatio
nsincludingdoctors,
lawyers,
executives,
graduate
students,
smallbusiness
owners
115
RR–notstated
62%
39yrs
Cross
sectional
survey
Prevalence:
Not
Stated;MeanIP
score
(Clance20
item
scale)
was
53.61,
SD13.22.
Self-handicappingtendencies
correlate
positiv
elywith
feelings
ofim
postorism.
Impostor
scores
correlatenegativ
elywith
paternal
care/warmth,they
show
nosignificantcorrelationwith
maternal
care/warmth.Im
postor
scores
correlate
positiv
elywith
both
maternalandpaternal
overprotectio
nscores.A
similarpattern
ofcorrelations
isevidentforthe
Self-H
andicappingScale,yetthereare
significantnegativ
ecorrelations
between
self-handicappingandboth
parental
care/warmth
scores.Higherim
postor
scores
correlatewith
lower
confidence
levels,but
notwith
theaccuracy
scoreof
thetest.
There
areno
significantcorrelations
betweenageandeither
self-handicappingor
imposter
feelings.
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1269
assessment for impostor syndrome—thereby potentiallyinvalidating these tools for minority populations.29
Employed Populations. Nineteen of the included articlesdescr ibed impostor syndrome among employedpopulations.9, 11, 14, 15, 26, 32, 37, 38, 40, 44, 46–48, 53, 58, 59, 62,72, 74 Five of these were of nurses and physicians,9, 40, 44, 46, 62
the rest included managers, teachers, and accountants, amongothers. Given the tendency of people with impostor syndrome toaggressively pursue achievement while not being able to acceptrecognition when success is achieved, affected employees mayexperience increased levels of stress, burnout, and decreased jobperformance and satisfaction over time.26, 37, 72 Employees whopersistently question their professional legitimacy are at higherrisk for experiencing adverse psychological outcomes withimplications to career retention, advancement, and jobperformance. Moreover, impostor feelings among employees isassociated with fear of failure, fear of success, and low self-esteem.58 Employees who report more impostor feelings reportless career planning and motivation to lead.58, 60
Bechtoldt found that supervisors across a variety of indus-tries scoring high on impostorism were more inclined todelegate both routine and challenging tasks to subordinateswho doubted their own professional abilities.11
Crawford et al. found a significant relationship betweenimpostor syndrome and self-reported conflict managingwork/life balance among community college employees; how-ever, this relationship was minimized if employees perceived
greater organizational support.26 This suggests a role for man-agers and executives in mitigating the effects of impostorsyndrome on employees.Together, these findings suggest that individuals who strug-
gle with impostor syndrome may be limited in their ability tofully develop their professional potential and may be a signif-icant contributor to burnout both among healthcare profes-sionals and others.
Diagnostic Tools
Several tools have been developed to assess impostor syn-drome. The preponderance of included articles used theClance Imposter Phenomenon Scale (or its German transla-tion),75 a 20-item scale on a 5-point Likert scale related to self-assessed competency, praise, and success. Six studies16, 27, 29,45, 49, 61 used the Harvey Impostor Phenomenon Scale(HIPS),76 a 14-item questionnaire on a 7-point Likert scaleregarding personality traits (where a higher score indicatesgreater identification with impostor syndrome). Two used theLeary Imposter Scale,55, 56 two used self-developed question-naires,15, 19 one45 used the Perceived Fraudulence Scale,1 andone used the Young Imposter scale.73
There is considerable variation in how researchers interpretspecific scores on the impostor syndrome diagnostic scales.For some, a score of < 40 on the CIPS denotes no impostorism,40–59 mild, 60–79 moderate, and > 80 as severe impostorfeelings.75 Others recommend using a score of 62 on the
Figure 3 Distribution of mean age among the included studies. Presents the distribution of mean age for the included studies.
Figure 2 Included studies by publication year. Presents the distribution of the included studies by year of publication.
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1270
CIPs77 or use the median CIP score in their population25 todistinguish impostors from non-impostors.We note the cutoffsused, when reported.
Prevalence
Few of the included studies were designed to assess theprevalence of impostor syndrome, which varied widely from9 to 82% largely depending on the screening tool and cutoffused to assess symptoms. For example, Chae et al.18 foundthat the prevalence of impostor syndrome among 654 KoreanCatholics varied from 24% using a CIPS cutoff of 62 to 39%using a cutoff of 58. We suspect that the included literature onthe prevalence of impostor syndrome may be subject to pub-lication bias (i.e., the tendency of journals to publish studieswith positive findings rather than negative findings) since allof the included studies reported some participants endorsingimpostor feelings.
Predictors of Impostor Syndrome
Gender Effects. Thirty-three articles compared the rates ofimpostor syndrome by gender.10, 14, 18, 21, 23, 25, 27, 28, 32, 35–39, 42, 43, 45–50, 54, 57, 62, 63, 68, 70, 72, 73 Sixteen of these foundthat women reported statistically significantly higher rates ofimpostor feelings than men.23, 28, 33, 35–39, 42, 43, 46, 50, 57, 62, 63,73 Hutchins and colleagues found that men and women copedifferently with their impostor feelings.37, 38 In contrast, 17studies found no difference in rates of impostor syndromebetween men and women.10, 18, 21, 24, 25, 27, 32, 40, 45, 47–49,53 , 54 , 68 , 70 , 72 Brauer and Proyer studied twopopulations—psychology students and professionals—andfound gender effects for impostor syndrome only among thestudents, not the professionals.14 Thus, the body of evidencesuggests that while impostor syndrome is common in women,it also affects men.
Age Effects. Six studies compared the rates of impostorsyndrome by age.14, 18, 49, 62, 70, 74 Two studies reported thatincreased age was associated with decreased impostorfeelings.18, 70 Three studies found no age effect.49, 62, 74
Brauer and Proyer evaluated impostor syndrome in twocohorts (244 psychology students and 222 workingprofessionals in Germany)—they found that age wassignificantly negatively correlated with impostor feelingsamong working professionals but not undergraduates.14
Notably, in their study, the age range of the workingprofessionals was much larger than that of the students,perhaps contributing to the likelihood of finding an age effect.
Comorbid Conditions
Many included articles explored the psychological issues thatare often found to co-exist with impostor syndrome including
depression,41, 47–49, 57, 62, 69, 78 anxiety,34, 41, 79, 80 low self-esteem,58, 62 somatic symptoms, and social dysfunctions.41
Impostor feelings among high school students correlated sig-nificantly with a history of prior suicidal ideation and attemptsand depression.49 Clearly, the care of patients with impostorsyndrome requires a careful assessment for comorbid condi-tions and treatment of them in addition to addressing theimpostor feelings.
Treatment
None of the included articles presented an evaluation of aspecific treatment (e.g., cognitive behavioral therapy) for man-aging impostor symptoms. A 1985 paper by Matthews andClance qualitatively described their experiences in privatepractice caring for 41 people with impostor feelings.53 Theyrecommended validating patients’ doubts and fears, directlyaddressing fears of failure, and providing group therapy sincethese patients often feel isolated and that they alone experienceimpostor feelings; however, no data were presented on treat-ment intensity, duration, or improvements on any diagnostictool.
Lay Literature Results
We found considerable lay interest in impostor syndrome.During the year (March 28, 2018–March 18, 2019), 2317Internet articles were published on impostor syndrome (150–200 articles/month). These resulted in 133,425 engagements(e.g., “likes,” re-postings, comments) on social media plat-forms such as Facebook and Twitter. While numerous Internetusers interacted with content originating from sites like Psy-chology Today (968 engagements), the majority of readersengaged with articles posted on blogging platforms like Me-dium.com (3111 engagements) or sites targeted toward pro-fessionals, like Inc.com (1568 engagements), LinkedIn.com(795 engagements), and Forbes.com (688 engagements).81
A detailed review of the content of these articles is outsidethe scope of this study. However, the vast majority weretagged as “What is…” articles, which define impostor syn-drome followed by “How-To” articles, which offer treatmenttips.Many of the articles classified as “What is…” articles alsoinclude tips about how to manage impostor syndrome. Thesetips run the gamut from “embracing authenticity” to “compar-ing notes with peers and mentors about shared impostor feel-ings”; however, much of this advice involves changing thethought processes that affirm feeling like a fraud. In 2018,Time Magazine published an article with an accompanyingshort video entitled, “Yes, Imposter syndrome is real. Here’show to deal with it.”82 Among other suggestions, they recom-mend that people suffering with impostor syndrome learn toreframe their thoughts and visit a psychologist.Notably, whereas the academic literature on the topic is
nearly all indexed with the term Impostor Phenomenon, theentirety of the lay literature is indexed with the term ImposterSyndrome.
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1271
DISCUSSION
This, the first published systematic review of the literature onimpostor syndrome which includes a novel, if somewhat uncon-ventional lay literature review, has six key findings. First, wefound a large peer-reviewed literature of more than 60 studies,half of whichwere published in the last 6 years. This is congruentwith the recent explosion in interest on the topic of impostorsyndrome in the lay literature. There are several gaps between thepeer-reviewed and lay literatures including that academics preferthe term Impostor Phenomenon while lay authors use ImposterSyndrome. Whereas the published literature included no studiesof interventions to treat impostor syndrome, the lay literatureabounds with advice on how to manage impostor symptoms.83,84 Given the current state of the peer-reviewed literature, mentalhealth professionals faced with patients suffering from impostorsyndromewill likely use evidence-based treatments for comorbidconditions such as cognitive behavioral therapy for depressionand anxiety, but do not have an evidence base upon which to relyspecifically for the impostor symptoms. This is a critical gap inthe published literature—we recommend a prospective evalua-tion of the use of individual and group cognitive behavioraltherapy focused on addressing impostor feelings on clinical andworkplace outcomes for employed populations across a range ofprofessions. Moreover, we recommend that impostor syndromebe considered for inclusion in the Diagnostic and StatisticalManual of Mental Disorders (DSM) so that the approach topatients with these symptoms can be codified for behavioralhealth providers.Second, much of the earliest literature on impostor syndrome
focused on women. While women do suffer from impostorsyndrome, half of the included studies that reported evaluatinga gender effect found no difference in the rates of men andwomen suffering from impostor syndrome. An implication ofthis finding is that clinicians and employers should be alert forimpostor feelings in their entire population, not just women.Third, numerous studies found impostor syndrome to be prev-
alent among ethnic minorities. A key finding from one of thesestudies is that impostor syndrome is a stronger predictor ofmentalhealth issues than minority status stress. This is particularlysignificant given that research on ethnic minority populationstends to focus on their minority status and presumed experiencesof discrimination, rather than the individual differences within aminority group such as the impostor syndrome. Another impor-tant finding is that attempts to standardize impostor syndromeassessments typically include small numbers of ethnic minorities,which raises questions of whether current impostor measures arevalid for ethnic minority populations.85
Fourth, it would be reassuring to believe that impostorsymptoms decline with age. Unfortunately, half of the sixstudies that reported on age effects found that impostor symp-toms decline with age but half did not. Clearly, this is a keyopen question that future studies evaluating employed popu-lations (rather than just evaluating students) could address.
Fifth, depression and anxiety are frequently comorbid withimpostor feelings. In the absence of specific treatment recom-mendations for impostor syndrome, patients with impostorfeelings should be rigorously screened for depression andanxiety and treated for these with evidence-based therapies.Individuals experiencing impostor syndrome often perceivethemselves to be the “only one” having these feelings,resulting in even greater isolation.53 Thus, referral to grouptherapy in which peers/coworkers discuss their feelings ofdoubt and failure might be particularly therapeutic. Cliniciansand other high-achieving professionals may be reluctant toparticipate in such groups unless they are carefully designedto normalize and destigmatize impostor feelings and provide asafe environment in which to share experiences openly.Finally, there is robust literature that describes the harmful
association between impostor feelings and job performance,job satisfaction, and burnout among various employee popula-tions, including healthcare professionals. In light of this evi-dence, we encourage professors and employers to incorporaterecognition of this phenomenon in the development of bothstructured (e.g., training, orientation, onboarding) and unstruc-tured (e.g., mentoring, coaching, self-directed learning) learn-ing and career development activities. Success-oriented em-ployees such as clinicians commonly have a thirst for trainingand personal growth. Offering resources such as access totherapy and resilience trainings that focus on impostor syn-drome could help reduce the prevalence of impostorism inemployed populations. When applicable, de-identified assess-ments can help the employees evaluate their personal changeover time, while enabling managers to assess the impact of thestructured intervention. In addition to structured and unstruc-tured learning, professors and employers can target impostorsyndrome by creating healthier expectations and a culturewhere mistakes are not interpreted as failures and publiclyacknowledging and celebrating employee accomplishments.Our study reflects the limitations of the included studies. First,
nearly all studies were of the same design (cross-sectional sur-veys, often of convenience samples). The literature suffers froma lack of randomized and prospective trials and is likely subjectto publication bias. Second, theweightedmean age of the studiesthat reported the age of their population was 20 years old, afinding driven by the preponderance of student populationsamong the included articles. However, given that 19 of theincluded studies described impostor syndrome in employedpopulations, the results of this review are relevant to olderpopulations as well. Third, few studies addressed cliniciansoutside of academic environments—a critical gap given burnoutamong clinicians in a wide range of clinical settings. Addition-ally, the included studies evaluated workers only in a limitednumber of professional settings—none evaluated workers intechnology companies—an important limitation given theamount of lay literature specifically targeting this population.Finally, given the nature of the reported data, we were precludedfrom performing quantitative synthesis of the included studies.
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1272
Our study is the first published synthesis of the peer-reviewed evidence on impostor syndrome. Our results suggestthat impostor symptoms are prevalent among men and womenand members of multiple ethnic groups, and are significantlyassociated with worsened experiences both in academic andprofessional settings. The literature critically lacks thoughtfulevaluations of treatments of impostor feelings. We encouragecaregivers, professors, and employers to be mindful of thelikelihood of impostor syndrome in the populations under theircare and to take steps to mitigate these feelings.
Corresponding Author: Dena M. Bravata, MD, MS; Center forPrimary Care and Outcomes Research, Stanford University School ofMedicine, Stanford, CA, USA (e-mail: [email protected]).
Funding Information This work was funded by Crossover Health, aprovider of employer-sponsored health clinics.
Compliance with Ethical Standards:
The funder had no role in this study’s design, conduct, or reporting.
Conflict of Interest: All authors except for Dr. Cokley were eitheremployees of or consultants to Crossover Health, the funder of thisstudy. Dr. Cokley received no financial support for his participation inthis study.
Open Access This article is distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricteduse, distribution, and reproduction in any medium, provided you giveappropriate credit to the original author(s) and the source, provide alink to the Creative Commons license, and indicate if changes weremade.
REFERENCES1. Kolligian J Jr, Sternberg RJ. Perceived fraudulence in young adults: is
there an "imposter syndrome"? J Pers Assess 1991;56(2):308-26.2. Clance PR, Imes SA. The imposter phenomenon in high achieving
women: Dynamics and therapeutic intervention. Psychother Theory ResPract 1978;15(3):241-7.
3. Clance PR. The Impostor Phenomenon: When Success Makes You FeelLike a Fake. Atlanta: Peachtree Publishers; 1985.
4. Hawley K. Feeling a Fraud? It’s not your fault! We can all work togetheragainst Imposter Syndrome [Internet]. 2016 [cited 2019 April 16].Available from: https://www.psychologytoday.com/us/blog/trust/201607/feeling-fraud-its-not-your-fault.
5. Harvey JC, Katz C. If I’m So Successful Why Do I Feel Like a Fake? . NewYork: St. Martin’s Press; 1985.
6. American Psychiatric Association. Diagnostic and Statistical Manual ofMental Disorders. 5th ed; 2013.
7. World Health Organization (WHO). International Classification of Dis-eases (ICD). 2015.
8. Arena DM, Page NE. The imposter phenomenon in the clinical nursespecialist role. Image J Nurs Sch 1992;24(2):121-5.
9. Ares TL. Role Transition After Clinical Nurse Specialist Education. ClinNurse Spec 2018;32(2):71-80.
10. Austin CC, Clark EM, Ross MJ, Taylor MJ. Impostorism as a mediatorbetween survivor guilt and depression in a sample of African Americancollege students. Coll Stud J. 2009;43(4, PtA):1094-109.
11. Bechtoldt MN. Wanted: Self-doubting employees—Managers scoringpositively on impostorism favor insecure employees in task delegation.Personal Individ Differ 2015;86:482-6.
12. Bernard DL, Lige QM, Willis HA, Sosoo EE, Neblett EW. Impostorphenomenon and mental health: The influence of racial discriminationand gender. J Couns Psychol 2017;64(2):155-66.
13. Bernard DL, Hoggard LS, Neblett EW. Racial discrimination, racialidentity, and impostor phenomenon: A profile approach. Cult Divers EthnMinor Psychol 2018;24(1):51-61.
14. Brauer K, Proyer RT. Are impostors playful? Testing the association ofadult playfulness with the Impostor Phenomenon. Personal Individ Differ2017;116:57-62.
15. Byrnes KD, Lester D. The imposter phenomenon in teachers andaccountants. Psychol Rep. 1995;77(1):350.
16. Caselman TD, Self PA, Self AL. Adolescent attributes contributing to theimposter phenomenon. J Adolesc 2006;29(3):395-405.
17. Castro DM, Jones RA, Mirsalimi H. Parentification and the impostorphenomenon: An empirical investigation. Am J Fam Ther2004;32(3):205-16.
18. Chae JH, Piedmont RL, Estadt BK, Wicks RJ. Personological evalua-tion of Clance's Impostor Phenomenon Scale in a Korean sample. J PersAssess 1995;65(3):468-85.
19. Chayer M-H, Bouffard T. Relations between impostor feelings andupward and downward identification and contrast among 10- to 12-year-old students. Eur J Psychol Educ 2010;25(1):125-40.
20. Christensen M, Aubeeluck A, Fergusson D, Craft J, Knight J,Wirihana L, et al. Do student nurses experience Imposter Phenom-enon? An international comparison of Final Year UndergraduateNursing Students readiness for registration. J Adv Nurs2016;72(11):2784-93.
21. Cokley K, McClain S, Enciso A, Martinez M. An examination of theimpact of minority status stress and impostor feelings on the mentalhealth of diverse ethnic minority college students. J Multicult Couns Dev2013;41(2):82-95.
22. Cokley K, Smith L, Bernard D, Hurst A, Jackson S, Stone S, et al.Impostor feelings as a moderator and mediator of the relationshipbetween perceived discrimination and mental health among racial/ethnic minority college students. J Couns Psychol 2017;64(2):141-54.
23. Cokley K, Awad G, Smith L, Jackson S, Awosogba O,Hurst A, et al. Theroles of gender stigma consciousness, impostor phenomenon andacademic self-concept in the academic outcomes of women and men.Sex Roles 2015;73(9-10):414-26.
24. Cowman SE, Ferrari JR. Am I for real? Predicting impostor tendenciesfrom self-handicapping and affective components. Soc Behav Pers2002;30(2):119-26.
25. Cozzarelli C, Major B. Exploring the validity of the impostor phenome-non. J Soc Clin Psychol 1990;9(4):401-17.
26. Crawford WS, Shanine KK, Whitman MV, Kacmar KM. Examining theimpostor phenomenon and work-family conflict. J Manag Psychol2016;31(2):375-90.
27. Cromwell B, Brown NW, Sanchez-Huceles J, Adair FL. The ImpostorPhenomenon and personality characteristics of high school honorstudents. J Soc Behav Pers 1990;5(6):563-73.
28. Cusack CE, Hughes JL, Nuhu N. Connecting gender and mental healthto imposter phenomenon feelings. Psi Chi Journal of PsychologicalResearch. 2013;18(2):74-81.
29. Ewing KM, Richardson TQ, James-Myers L, Russell RK. The relation-ship between racial identity attitudes, worldview, and African Americangraduate students' experience of the imposter phenomenon. J BlackPsychol 1996;22(1):53-66.
30. Ferrari JR. Impostor tendencies and academic dishonesty: Do they cheattheir way to success? Soc Behav Pers 2005;33(1):11-8.
31. Ferrari JR, Thompson T. Impostor fears: Links with self-presentationalconcerns and self-handicapping behaviours. Personal Individ Differ2006;40(2):341-52.
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1273
32. Fried-Buchalter S. Fear of success, fear of failure, and the imposterphenomenon among male and female marketing managers. Sex Roles1997;37(11-12):847-59.
33. Ghorbanshirodi S. The relationship between self-esteem and emotionalintelligence with imposter syndrome among medical students of Guilanand Heratsi Universities. J Basic Appl Sci Res 2012;2(2):1793-802.
34. Gibson-Beverly G, Schwartz JP. Attachment, entitlement, and theimpostor phenomenon in female graduate students. J Coll Couns2008;11(2):119-32.
35. Hayes KM, Davis SF. Interpersonal flexibility, Type A individuals, and theimpostor phenomenon. Bull Psychon Soc 1993;31(4):323-5.
36. Henning K, Ey S, Shaw D. Perfectionism, the impostor phenomenon andpsychological adjustment in medical, dental, nursing and pharmacystudents. Med Educ 1998;32(5):456-64.
37. Hutchins HM, Rainbolt H. What triggers imposter phenomenon amongacademic faculty? A critical incident study exploring antecedents, coping,and development opportunities. HumResour Dev Int 2017;20(3):194-214.
38. Hutchins HM, Penney LM, Sublett LW. What imposters risk at work:Exploring imposter phenomenon, stress coping, and job outcomes. HumResour Dev Q 2017.
39. Jöstl G, Bergsmann E, Lüftenegger M, Schober B, Spiel C. When willthey blow my cover? The impostor phenomenon among Austrian doctoralstudents. Z Psychol 2012;220(2):109-20.
40. Kamarzarrin H, Khaledian M, Shooshtari M, Yousefi E, Ahrami R. Astudy of the relationship between self-esteem and the imposter phenom-enon in the physicians of Rasht city (Iran). Eur J Exp Biol 2013;3(2):363-6.
41. Kananifar N, Seghatoleslam T, Atashpour SH, Hoseini M, HabilMHB, Danaee M. The relationships between imposter phenomenonand mental health in Isfahan universities students. Intern Med J2015;22(3):144-6.
42. King JE, Cooley EL. Achievement orientation and the impostor phenom-enon among college students. Contemp Educ Psychol 1995;20(3):304-12.
43. Kumar S, Jagacinski CM. Imposters have goals too: The imposterphenomenon and its relationship to achievement goal theory. PersonalIndivid Differ 2006;40(1):147-57.
44. LaDonna KA, Ginsburg S, Watling C. “Rising to the Level of YourIncompetence”: What Physicians' Self-Assessment of Their PerformanceReveals About the Imposter Syndrome in Medicine. Acad Med2018;93(5):763-8.
45. Leary MR, Patton KM, Orlando AE, Wagoner Funk W. The impostorphenomenon: Self-perceptions, reflected appraisals, and interpersonalstrategies. J Pers 2000;68(4):725-56.
46. Legassie J, Zibrowski EM, Goldszmidt MA. Measuring resident well-being: Impostorism and burnout syndrome in residency. J Gen InternMed 2008;23(7):1090-4.
47. Leonhardt M, Bechtoldt MN, Rohrmann S. All impostors aren’talike—Differentiating the impostor phenomenon. Front Psychol 2017;8.
48. Rohrmann S, Bechtoldt MN, Leonhardt M. Validation of the impostorphenomenon among managers. Front Psychol 2016;7.
49. Lester D, Moderski T. The imposter phenomenon in adolescents.Psychol Rep 1995;76(2):466.
50. Li S, Hughes JL, Thu SM. The links between parenting styles andimposter phenomenon. Psi Chi J Psychol Res 2014;19(2):50-7.
51. Lige QM, Peteet BJ, Brown CM. Racial identity, self-esteem, and theimpostor phenomenon among African American college students. J BlackPsychol 2017;43(4):345-57.
52. Peteet BJ, Brown CM, Lige QM, Lanaway DA. Impostorism is associatedwith greater psychological distress and lower self-esteem for AfricanAmerican students. Curr Psychol 2015;34(1):154-63.
53. Matthews G, Clance PR. Treatment of the impostor phenomenon inpsychotherapy clients. Psychother Priv Pract 1985;3(1):71-81.
54. McClain S, Beasley ST, Jones B, Awosogba O, Jackson S, Cokley K. Anexamination of the impact of racial and ethnic identity, impostor feelings,and minority status stress on the mental health of Black college students.J Multicult Couns Dev 2016;44(2):101-17.
55. McElwee ROB, Yurak TJ. Feeling versus acting like an impostor: Realfeelings of fraudulence or self-presentation? Individ Differ Res2007;5(3):201-20.
56. McElwee ROB, Yurak TJ. The phenomenology of the impostor phenom-enon. Individ Differ Res 2010;8(3):184-97.
57. McGregor LN, Gee DE, Posey KE. I feel like a fraud and it depresses me:The relation between the imposter phenomenon and depression. SocBehav Pers 2008;36(1):43-8.
58. Neureiter M, Traut-Mattausch E. An inner barrier to career develop-ment: Preconditions of the impostor phenomenon and consequences forcareer development. Front Psychol 2016;7.
59. Neureiter M, Traut-Mattausch E. Inspecting the Dangers of Feeling likea Fake: An Empirical Investigation of the Impostor Phenomenon in theWorld of Work. Front Psychol. 2016;7:1445.
60. Neureiter M, Traut-Mattausch E. Two sides of the career resources coin:Career adaptability resources and the impostor phenomenon. J VocatBehav 2017;98:56-69.
61. Okoth A, Moderski T, Lester D. Impostor feelings in disturbedadolescents. Psychol Rep. 1994;75(3, Pt 2):1538.
62. Oriel K, Plane MB, Mundt M. Family Medicine Residents and theImpostor Phenomenon. Fam Med 2004;36(4):248-52.
63. Patzak A, Kollmayer M, Schober B. Buffering impostor feelings withkindness: The mediating role of self-compassion between gender-roleorientation and the impostor phenomenon. Front Psychol 2017;8.
64. Peteet BJ, Montgomery L, Weekes JC. Predictors of imposter phenom-enon among talented ethnic minority undergraduate students. J NegroEduc 2015;84(2):175-86.
65. Robinson SL, Goodpaster SK. The effects of parental alcoholism onperception of control and imposter phenomenon. Curr Psychol1991;10(1-2):113-9.
66. Schubert N, Bowker A. Examining the impostor phenomenon in relationto self-esteem level and self-esteem instability. Curr Psychol. 2017.
67. Selby CLB, Mahoney MJ. Psychological and physiological correlates of self-complexity and authenticity. Constructivism Hum Sci 2002;7(1-2):39-52.
68. September AN, McCarrey M, Baranowsky A, Parent C, Schindler D.The relation between well-being, impostor feelings, and gender roleorientation among Canadian university students. J Soc Psychol2001;141(2):218-32.
69. Sonnak C, Towell T. The impostor phenomenon in British universitystudents: Relationships between self-esteem, mental health, parentalrearing style and socioeconomic status. Personal Individ Differ2001;31(6):863-74.
70. Thompson T, Davis H, Davidson J. Attributional and affective responsesof impostors to academic success and failure outcomes. Personal IndividDiffer 1998;25(2):381-96.
71. Thompson T, Foreman P, Martin F. Impostor fears and perfectionistconcern over mistakes. Personal Individ Differ 2000;29(4):629-47.
72. Vergauwe J, Wille B, Feys M, De Fruyt F, Anseel F. Fear of beingexposed: The trait-relatedness of the impostor phenomenon and itsrelevance in the work context. J Bus Psychol 2015;30(3):565-81.
73. Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome andburnout among American medical students: a pilot study. Int J Med Educ2016;7:364-9.
74. Want J, Kleitman S. Imposter phenomenon and self-handicapping:Links with parenting styles and self-confidence. Personal Individ Differ2006;40(5):961-71.
75. Clance PR, O'Toole MA. The Imposter Phenomenon: An internal barrierto empowerment and achievement. Women Ther 1987;6(3):51-64.
76. Harvey JC. The Impostor Phenomenon and Achievements: A Failure toInternalize Success. In: International DA, ed. Philadelphia: TemplteUniversity; 1981:4969-70B.
77. Holmes SW,Kertay L, Adamson LB,Holland CL, Clance PR.Measuringthe imposter phenomenon: A comparison of Clance's IP scale andHarvey's I-P scale. J Pers Assess 1993;60(1):48-59.
78. Chrisman SM, Pieper WA, Clance PR, Holland CL, Glickauf-Hughes C.Validation of the Clance Imposter Phenomenon Scale. J Pers Assess1995;65(3):456-67.
79. Bernard NS, Dollinger SJ, Ramaniah NV. Applying the big fivepersonality factors to the impostor phenomenon. J Pers Assess2002;78(2):221-33.
80. Ross SR, Stewart J, Mugge M, Fultz B. The imposter phenomenon,achievement dispositions, and the Five Factor Model. Personal IndividDiffer 2001;31(8):1347-55.
81. BuzzSumo. “Imposter Syndrome” Search [Internet]. 2019 [cited 2019April 16]. Available from: https://app.buzzsumo.com/research/content(Subscription required).
Bravata et al.: Impostor Syndrome: a Systematic Review JGIM1274
82. Abrams A. Yes, Impostor Syndrome Is Real. Here’s How to Deal With It.Time. 2018; June 20.
83. Eschenroeder K. 21 Proven Ways to Overcome Impostor Syndrome[Internet]. StartupBros; 2018 [cited 2019 April 16]. Available from:https://startupbros.com/21-ways-overcome-impostor-syndrome/.
84. Eschenroeder K. Overcome Impostor Syndrome: What to Do When YouFeel Like a Fraud [Internet]. lifehacker; 2014 [cited 2019 February 17].Available from: https://lifehacker.com/overcoming-impostor-syndrome-what-to-do-when-you-feel-1651827849.
85. Stone S, Saucer C, Bailey M, Garba R, Hurst A, Jackson S, et al.Learning while Black: A culturally informed model of the impostorphenomenon for Black graduate students. J Black Psychol2018;44(6):491-531.
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Appendix
Search Terms
The following search terms were used to identify articles indexed between January 1966 and May 2018. We did not limit by language publicationtype or other terms
• Imposter Syndrome*
• Imposter Phenomenon*
• Impostor Syndrome*
• Impostor Phenomenon*
• Imposter Phenomenon AND/OR Imposter Syndrome
• Impostor syndrome AND/OR Impostor phenomenon*
Bravata et al.: Impostor Syndrome: a Systematic ReviewJGIM 1275