The SIR Annual Scientific Meeting used to be a lonely week for me. While I was surrounded by peers, I felt isolated from the group. On lucky days, I’d run into a colleague from training and we’d catch up for a few minutes. But during these conversations, I often felt I had little to show for all my once-great potential and years of grinding post-fellowship work. I would often wonder how I had gotten so lost in my career—despite my accomplishments, I sometimes felt like I wasn’t a “primetime” IR.
In a conversation with Daniel Y. Sze, MD, PhD, FSIR, editor-in-chief of the Journal of Vascular and Interventional Radiology, he asked me, “Do you have impostor syndrome?” I’d never heard of it and thought he’d invented it as a foil to challenge some of my self-deprecating comments. Later in the week, I saw an article on impostor syndrome featured in a prominent medical journal. After reading the article, I realized I had a pernicious, toxic and perhaps end-stage case of impostor syndrome.
For the first time, I glimpsed the impostor within myself and better understood the dynamics behind the problematic trajectory of my career. I realized impostor syndrome had robbed me of some professional and personal opportunities and kept me mired in unsatisfying situations. What I have since discovered is that impostor syndrome is a pervasive phenomenon that cuts broadly throughout society and impacts professional fields—especially medicine.
What is imposter syndrome?
Figure 1: The imposter cycle
Impostor syndrome (also known as impostor phenomenon and impostorism) is a psychological term first used in 1978 to describe a range of behaviors, feelings and attitudes rooted in a sense of unworthiness that affects an individual’s emotional well-being and professional functioning.1 Psychologists Pauline Rose Clance, PhD, and Suzanne Imes, PhD, describe it as the feeling of “phoniness in people who believe that they are not intelligent, capable or creative despite evidence of high achievement.” Those affected are often very accomplished but hold internal doubts about their abilities and professional legitimacy and fear being exposed as fraudulent.1,2
Once imposter syndrome is activated, it can perpetuate a self-reinforcing cycle. This dynamic may produce feelings of excessive anxiety, poor self-esteem, self-doubt, frustration and depression. Those affected may attribute their accomplishments to luck or happenstance rather than earned merit and may wonder if they have fooled others into believing they are authentically competent.3,6
The impostor cycle
Those affected by impostor syndrome experience a familiar and troubling cycle of professional dysfunction. Their sense of inadequacy can lead to an attempt to compensate via overwork and a rigid adherence to perfectionism. This hard work usually pays dividends in demonstrable success and peer approval, which leads to a transient sense of accomplishment and worthiness. However, these feelings are short-lived and eventually the individual returns to focusing on their self-perceived inadequacy. Common professional setbacks can also accelerate the cycle—for example, medical errors or poor patient outcomes can be devastating to affected practitioners and amplify feelings of guilt, unworthiness and self-doubt.3
Many are often not aware of the cycle and may be reluctant to discuss their feelings with peers for fear of being judged or undermining their own hard-won achievements. This fear of being judged not only makes it difficult to discuss feelings but can also lead to professional isolation and fewer opportunities for peer support and mentoring.
Studies suggest that as much as 70% of the population has experienced symptoms of impostorism at some point in their life, most often as a response to a new environment or relationship. For some the condition is transient, but for many others the cycle becomes chronic. It is believed to exist almost equally in men and women, though it may be expressed quite differently between the genders.1,4
In one study, men who suffered from impostor syndrome often sought situations where they were less likely to be viewed as “frauds” and compared themselves to peers who were less qualified. This scenario can protect an individual’s self-esteem but impairs their ability to fulfill their full potential.5-7 In contradistinction, the study showed that women more often delve deeply into competitive spaces but are constantly plagued by feelings of inadequacy. Again, this impairs professional enjoyment and development.
Impostor syndrome and IR
The pervasiveness of impostor syndrome within the radiology and IR workforce is unclear. However, a study published in November 2021 found that in one academic radiology group, 83% of respondents to a survey reported experiencing impostorism. In this group, there was a high correlation between impostorism and professional burnout.9,11 The number of impacted individuals may be the same in IR, as evidenced by an informal online survey performed by Robert K. Ryu, MD, FSIR, in which 87% of 277 respondents identified feelings of impostorism.7 This indicates that impostorism in IR may be rampant but is largely unacknowledged and untreated.
In general, those affected by impostorism have lower career satisfaction than those who do not but demonstrate much deeper levels of organizational commitment.8 However, they struggle to market themselves, which impacts their salaries and professional development. Over time, those affected discount or reject their own viewpoints, credibility and authority—robbing themselves, their organization and patients of the benefits of their potential.
IR is a highly innovative and prestigious specialty that demands its practitioners to be hardworking, selfless, detail oriented and high achieving. This is the kind of fertile cultural soil in which impostor syndrome thrives. But if overwork, exhaustion and perfectionism are institutionally rewarded, impostorism will be fortified, potentially degrading the morale of those affected and the mission of the organization.
Origins and drivers of impostor syndrome
The origins of imposter syndrome were initially postulated to come from individual character traits such as low self-esteem, perfectionism in high achievers and an internalized flawed logic linking self-worth to achievement. However, more contemporary studies suggest impostor phenomenon is more often a reaction to external interpersonal and societal factors.2 In many of those affected, past trauma, family dynamics and deeply held personal beliefs may be the chief drivers of impostorism.
Women, racial and ethnic minorities as well as sexual and gender minorities who lack the privilege of some of their peers are particularly susceptible to this experience.3,4,10 In short, impostor syndrome is often a personalized manifestation of a multitude of interpersonal and societal factors. Specifically, stereotypes and low representation in the workforce can reinforce notions in individuals that they are out of place, unusual or inferior. The very presence of an individual from an underrepresented minority in academic or workplace spaces may illicit insinuations that they were given preferential treatment to achieve their status.6 Thus, the cultural environment itself is informing their belief that they are an impostor. Perceived stress among minorities with impostorism is amplified when overt discrimination is encountered. Kevin Cokley, PhD, a professor of educational psychology and African Diaspora Studies at the University of Texas at Austin, studies the phenomenon and found impostorism to be an even greater predictor of negative mental health outcomes in minorities than discrimination.4
Conclusion
Imposter syndrome isn’t the commonplace and transient self-doubt and angst almost all professionals occasionally experience. It’s not isolated to women, racial, ethnic, or sexual and gender minorities. It doesn’t take root only in those who suffer the burdens of depression and anxiety disorders—though it can engender and amplify these feelings. Impostorism cuts broadly through the whole of society and most often thrives in hardworking, deeply committed, purpose-driven high-achievers like interventional radiologists. Impostor syndrome and its insidious malcontent first-cousins—anxiety, depression and burnout—may be robbing us of the full human potential that we need as we strive to advance IR. For the benefit of our specialty, workforce and patients, in our next edition we will discuss ways to measure signs of impostorism and mechanisms to dismantle it.
References:
Clance, PR, Imes, SA.The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 1987;15(3):241–247.
Cokley, K., McClain, S., Enciso, A. and Martinez, M. An examination of the impact of minority status stress and impostor feelings on the mental health of diverse ethnic minority college students. J Multicult Couns Devel. 2013;41:82–95.
Feenstra S, Begeny CT, Ryan MK, Rink FA, Stoker JI, Jordan J. Contextualizing the impostor “syndrome.” Front Psychol. 2020;11:206.
Bravata DM, Watts SA, Keefer AL, et al. Prevalence, Predictors, and treatment of impostor syndrome: A systematic review. J Gen Intern Med. 2020;35(4):1252–1275.
Cokley K, Smith L, Bernard D, Hurst A, Jackson S, Stone S, Awosogba O, Saucer C, Bailey M, and Roberts D. Impostor feelings as a moderator and mediator of the relationship between perceived discrimination and mental health among racial/ethnic minority college students. J Couns Pyshcol. 2017;64(2):141–154.
Wong K. Dealing with impostor syndrome when you’re treated as an impostor. The New York Times. June 12, 2018.
Lapite A. Overcoming imposter syndrome in medicine. Wolters Kluwer. April 29, 2020.
Barraza M. Overcoming Imposter Syndrome (No. 150) [Audio podcast episode]. BackTable. 2021, August 23.
Arleo EK, Wagner-Schulman M, McGinty G, Salazar G, Mayr NA. Tackling impostor syndrome: A multidisciplinary approach. Clin Imaging. 2021 Jun;74:170-172.
Badawy RL, Gazdag BA, Bentley JR, Brouer RL. Are all impostors created equal? Exploring gender differences in the impostor phenomenon-performance link. Pers Individ Differ. 2018(131);156-163.
Deshmukh S, et al. Imposter phenomenon in radiology: incidence, intervention, and impact on wellness. Imaging. 2021 Nov 16;82:94-99
