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: dbravata@gmail.com).

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