Imposter syndrome: why capable people feel like frauds
Imposter syndrome — first described in 1978 as the ‘impostor phenomenon’ — is the persistent belief that your success comes from luck, charm or sheer hard work rather than ability, and that sooner or later people will discover you are not as capable as they think. It is not a mental illness or a formal diagnosis. It is common among students, new doctors and anyone entering an unfamiliar, high-pressure setting. It becomes a problem when it drives exhausting over-preparation, procrastination or avoidance, or when it sits alongside anxiety or depression.
Health writers · Aslam Clinic
Imposter syndrome is the feeling that you do not really deserve your place — that your marks, your job or your promotion came from luck, a kind examiner or simply working harder than everyone else, and that one day someone will notice you are not as able as they think. People who feel it are usually doing well by any outside measure. The feeling persists anyway, because each new success is explained away rather than counted.
It is not a diagnosis. A 2020 systematic review in the Journal of General Internal Medicine noted that imposter syndrome appears in neither the DSM nor the ICD, the manuals doctors use to diagnose mental illness. It is a pattern of thinking and behaving that many ordinary, healthy people recognise in themselves. It matters because it can wear people out, and because it often travels with , and .
Where the idea came from
Two American psychologists, Pauline Clance and Suzanne Imes, named the ‘impostor phenomenon’ in 1978 after working with more than 150 highly successful women — PhD holders, respected professionals and top students — who did not feel successful inside. Some believed they had been admitted by mistake; others put high exam scores down to luck or to misgrading. Clance and Imes noticed that repeated success did not break the belief. The women found new ways to dismiss each achievement.
Clance and Imes thought it was much more common in women. Later research is more mixed: in the 2020 review, 16 of 33 studies that compared the sexes found higher scores in women and 17 found no difference. The fair summary is that it is common in women and also affects men.
What it feels like
- Putting success down to luck, timing, contacts or a mistake, and failure down to your own lack of ability
- Fearing that the next exam, ward round or presentation will be the one that exposes you
- Being unable to take in praise — deflecting it, or assuming the person is just being kind
- Believing that truly able people succeed without effort, so needing to work hard ‘proves’ you are not really clever
- Comparing yourself with the most able person in every room
- Not asking questions, in case the question reveals what you do not know
- Feeling only brief relief after a success, followed quickly by dread about the next task
The impostor cycle
Clance later described a loop that keeps the feeling going. It explains why imposter syndrome is so tiring and why success alone does not cure it.
- A task arrives — an exam, a new rotation, a deadline — and brings worry and self-doubt.
- You respond either by over-preparing far beyond what is needed, or by putting it off and then working frantically at the last minute.
- The task goes well.
- You feel relief, but you credit the success to the extra effort (if you over-prepared) or to luck (if you left it late) — never to ability.
- The next task arrives and the doubt returns unchanged.
How common is it?
Headlines often quote a single figure such as ‘70% of people’. Treat these with caution. The 2020 review pooled 62 studies with 14,161 participants and found rates anywhere from 9% to 82%, depending mostly on which questionnaire was used and where the cut-off was set. What the research does show consistently is that imposter feelings are common in demanding fields and at points of transition.
Medicine is a good example. A 2020 article in Canadian Family Physician estimated that around 30% of medical students and residents identify as impostors, with higher rates in women and international graduates. A 2025 study of 230 MBBS students in Islamabad, using the Clance scale, found impostor feelings in every year of study, with first-year students scoring highest and women scoring higher than men.
Who is most likely to feel it
Imposter feelings tend to peak when you move into a setting where you do not yet know the rules, and where others seem to belong more naturally than you do.
- First-generation university students — the first in the family to reach university, often moving from a village or small town to Lahore, Islamabad or abroad, and sometimes from Urdu-medium schooling into English-medium lectures. A 2020 US study of 818 science students found that competitive classrooms increased daily imposter feelings in all students, but especially in first-generation students, and those feelings predicted lower attendance, engagement and grades.
- New doctors — house officers and trainees who are suddenly responsible for patients and surrounded by seniors who seem to know everything.
- People who changed status quickly — a first job, a promotion, a scholarship, a move abroad.
- People raised with labels — Clance and Imes described children cast as ‘the sensitive one’ beside a sibling labelled ‘the clever one’, and children praised as brilliant at everything who then decided that needing to study meant they were stupid.
- Anyone judged against family expectations — when a whole family has invested in one child's MDCAT or CSS result, every mark can feel borrowed rather than earned.
| Everyday self-doubt | Imposter pattern | May be something more |
|---|---|---|
| Nervous before a new challenge, settles as you learn | Doubt returns with every new task, however well the last one went | Constant worry about many things, not just performance |
| Can accept praise once the result is in | Praise feels undeserved or embarrassing | Feeling worthless in every area of life |
| Works hard when needed | Over-prepares or delays as a ritual | Cannot start or finish anything, even simple tasks |
| Mood is fine outside work or study | Tension centred on achievement | Low mood, poor sleep or loss of interest for two weeks or more |
What helps
An honest point first: the 2020 review found no published trials testing any treatment for imposter syndrome. The approaches below come from clinical experience and from cognitive behavioural principles that work for related problems. They are sensible and low-risk, but they are not proven cures.
- Name it and share it. Clance and Imes found that the most powerful moment in their groups was when one woman admitted the feeling and others realised they were not alone. A trusted friend, batchmate or senior who says ‘I felt that too’ can do the same.
- Keep an evidence file. Write down specific positive feedback, results and problems you solved, and notice how you tend to dismiss each one. Clance and Imes set this as homework for exactly that reason.
- Separate the feeling from the facts. ‘I feel like a fraud’ is a feeling. ‘I passed the exam and the consultant trusted me with the ward’ is a fact. Learning to spot such as discounting the positive and is the core of .
- Practise saying ‘thank you’. When someone praises your work, accept it without adding ‘but it was nothing’.
- Set a ‘good enough’ limit. Decide in advance how long preparation deserves, stop there, and see what happens. Change this in small steps — Clance warned that dropping over-work too fast can spike anxiety.
- Ask the question. Asking early is what competent people do. New doctors are expected not to know everything; they are expected to know when to ask.
- Look for specific feedback. Vague praise is easy to dismiss. Ask a supervisor what exactly you did well and what to improve.
When it is more than imposter feelings
Imposter feelings on their own do not need treatment. See a doctor or a if any of these apply:
- You have felt low, hopeless or lost interest in things you used to enjoy for two weeks or more
- Worry is constant, spreads beyond work or study, or brings panic, poor sleep or physical symptoms
- You are avoiding exams, shifts or opportunities because the fear is too strong
- You are exhausted, detached and cynical about work — signs of burnout
- You are relying on sleeping pills, tranquillisers or other substances to cope
For parents, teachers and senior doctors
- Praise specific effort and specific skill rather than calling a child ‘genius’ or ‘the clever one’.
- Avoid comparing siblings or cousins by their marks.
- Tell trainees about your own early doubts and mistakes. It normalises not knowing.
- Give feedback that is prompt, specific and fair, so people can calibrate their view of themselves against something real.
- Reduce needless competition in classrooms and wards; collaboration is where first-generation students do best.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
