Have you ever thought to yourself, ‘Am I really good at what I do, or have I just been lucky?’ This question might have crossed your mind at some point, and if so, you’ve likely experienced impostor syndrome (1). This psychological phenomenon affects millions of people, making them believe they’re not as competent as others perceive, despite evidence of their success (1). The emotional impact can be overwhelming, generating stress, anxiety, and even depression, especially in demanding environments like academia and the professional world (1,2).

The problem is that impostor syndrome doesn’t only damage people’s mental health, but it can also limit their growth and professional development (2). Those who suffer from it tend to underestimate their achievements, feel a constant fear of being exposed as “frauds,” and often avoid taking on new challenges for fear of failure (2). This combination of negative emotions creates a cycle that reinforces insecurity and affects productivity and personal happiness (1,2).

However, there is a solution, and it starts with knowledge (1). Understanding the neurobiological and psychological roots of impostor syndrome not only allows us to recognize it but also to address it effectively (1). From a neurobiological perspective, impostor syndrome has deep roots in the activation of the stress system, particularly in the hypothalamic-pituitary-adrenal (HPA) axis, responsible for regulating hormones like cortisol (1). The prolonged stress experienced by those suffering from this syndrome directly affects this system, producing an imbalance that can generate chronic feelings of anxiety and depression (1). The brain reacts to the perception of a constant threat, which activates primitive “fight or flight” responses, although in this case, the threat is purely psychological: the fear of being discovered as a fraud (1,2).

Other neurotransmitters like serotonin, oxytocin, and dopamine play a crucial role in this phenomenon (1). Serotonin and oxytocin, commonly associated with feelings of well-being and social trust, tend to be decreased in people who experience impostor syndrome, which aggravates the sensation of insecurity and lack of connection with the environment (1). On the other hand, dopamine, the neurotransmitter involved in the reward system, can also be affected, which prevents these people from feeling satisfaction or enjoying their achievements (1). This neurochemical imbalance not only contributes to feelings of inadequacy but also perpetuates the need to seek external validation (1).

Impostor syndrome is not exclusive to a particular population (3). In fact, it affects people at all professional and academic levels, although certain professions, like medicine, tend to show a higher prevalence (3). In a study conducted among medical students, it was found that almost half of the participants reported symptoms of impostor syndrome, with a significant relationship between high levels of stress, anxiety, and depression (3). The transitions in the educational environment.

This kind of environment fosters perfectionism and self-demand, two characteristics commonly found in individuals with impostor syndrome (3). Perfectionism creates an unattainable internal expectation, and when these impossible standards are not met, the individual feels even more incompetent (3). Despite evidence of success, these individuals believe that any achievement is due to luck and that they will eventually be exposed as frauds (3).

Fortunately, neuroscience also provides clues about how we can address this phenomenon (1). One key is working on stress management and developing emotional coping skills (1). Mindfulness and deep breathing techniques are tools that help regulate the HPA axis, reducing the fight-or-flight response and promoting a state of mental calm (1).

Another crucial aspect is changing the internal narrative (1,4). Many people with impostor syndrome suffer from what psychologists call cognitive distortions, that is, dysfunctional thought patterns that lead them to interpret reality negatively (4). An effective therapeutic approach is Cognitive-Behavioral Therapy (CBT), which helps to identify and modify these distortions, promoting a more realistic view of one’s own achievements and abilities (4).

Additionally, recent studies suggest that social support and mentoring are powerful tools to combat this syndrome (4). In environments such as medicine, where impostor syndrome is prevalent, the implementation of mentoring programs can help normalize difficulties and failures, and provide a safe space for individuals to discuss their fears without fear of judgment (3). Finally, it is important to remember that impostor syndrome is not a sign of weakness or incompetence (4). On the contrary, many people who experience it are in fact highly competent and successful individuals (4).

References:

1. Chrousos GP, Mentis AA, Dardiotis E. Focusing on the neuro-psycho-biological and evolutionary underpinnings of the impostor syndrome. Front Psychol. 2020;11:1553. doi: 10.3389/fpsyg.2020.01553.
2. Fleischhauer M, Wossidlo J, Michael L, Enge S. The Impostor Phenomenon: Toward a Better Understanding of the Nomological Network and Gender Differences. Front Psychol. 2021;12:764030. doi:10.3389/fpsyg.2021.764030.
3. Shinawatra P, Kasirawat C, Khunanon P, Boonchan S, Sangla S, Maneeton B, Maneeton N, Kawilapat S. Exploring Factors Affecting Impostor Syndrome among Undergraduate Clinical Medical Students at Chiang Mai University, Thailand: A Cross-Sectional Study. Behav Sci. 2023;13(12):976. doi:10.3390/bs13120976.
4. Bravata DM, Watts SA, Keefer AL, Madhusudhan DK, Taylor KT, Clark DM, et al. Prevalence, predictors, and treatment of impostor syndrome: a systematic review. J Gen Intern Med. 2020;35(4):1252–75. doi:10.1007/s11606-019-05364-1.