Special Interest Group Update

In each issue, one of NANN's special interest groups shares information in their area of focus.

Disclaimer:  The information presented and opinions expressed herein are those of the author and do not necessarily represent the views of the National Association of Neonatal Nurses.

E-News Encore: "Unveiling Impostor Syndrome: Navigating the Shadows Within"

Tosha Harris, DNP APRN NNP-BC, NANN E-News Editor

It's always fascinating to explore the depths of our minds and how they shape our identity. Impostor syndrome (IS) can be a difficult adversary to overcome. It's a powerful phenomenon that can make us doubt ourselves and our achievements. By reflecting on the interplay between self-doubt and achievement, we can better understand ourselves and challenge the impostor syndrome that may be holding us back.

IS is a psychological phenomenon that can have a significant impact on an individual's personal and professional development, particularly when combined with negative thought patterns. Although the precise cause of this condition is unknown, research has suggested that it may be influenced by a combination of familial, personal, and environmental factors (Hoang, 2013; Sakuluku & Alexander, 2011).

The term "impostor syndrome" was first identified by psychologists Clance and Imes in 1978, during their study of 150 highly successful women professionals. The study participants could not acknowledge or internalize their success, despite their many accomplishments. They experienced persistent feelings of self-doubt and believed that their success was due to luck or mistake. They lived in constant fear of being exposed as frauds or impostors. Impostorism can occur at any point in a person's professional career, but it is most common during times of transition or when faced with new challenges or responsibilities (LaDonna et al., 2018). These may include starting a new job, taking on a leadership role, or pursuing advanced education. In some cases, impostor syndrome may be temporary and dissipate over time as individuals become more comfortable in their new roles. However, for others, it may be a chronic personality trait that leads to persistent feelings of being an impostor. Overall, it is important to recognize and address impostor syndrome as it can have a significant impact on an individual's mental health and professional growth. By understanding the causes and symptoms of this condition, individuals can take steps to overcome it and reach their full potential.

Every individual has their own definition of competence. How you define competence directly impacts how competent you feel. According to Young (2021), a world-renowned expert on IS, individuals who have IS tendencies can be grouped into five categories based on each defined competence:   

1. The Perfectionist. The literature has shown there is a close association between perfectionism and IS. Perfectionists focus on task execution and how the result turns out. Anything less perfect equals failure (and subsequently shame) due to unrealistic high-set standards and expectations.  
2. The Expert. The expert focuses on what and how much they know and how much they can do. They believe they must know everything and fear exposure as inexperienced or unknowledgeable. A little lack of knowledge denotes failure. They are hesitant to ask questions or speak up in meetings because they're afraid of looking stupid if they don't know the answer. 
3. The Soloist. The soloist only cares about who completes the task. They desire to work alone. Assistance is equivalent to failure.   
4. The Natural Genius. This imposter cares about how and when tasks are completed. Competence is getting things done quickly and right the first time.   
5. The Superwoman/Superman. This imposter measures competence based on how many duties or roles they can balance and excel in. If they fall short in any role, this results in perceived failure and shame. The superwoman/superman is a workaholic. They are addicted to the validation that comes from working but are not addicted to work itself.  

To acquire confidence, it's imperative to engage in self-evaluation, identify areas for improvement, and redefine our personal understanding of competence. This process helps us to recognize our strengths and weaknesses and develop a plan for growth and development. It's crucial to eliminate self-limiting thought processes that may prevent us from reaching our full potential. Intermittent episodes of feelings of inadequacy and uncertainty are needed for professional growth and development. These brief occurrences serve as reminders to continue working on building our competency. When we experience moments of self-doubt, we can use them as opportunities to reflect on our progress and adjust our strategies accordingly.

However, problems arise when these tendencies are not managed. Walker (2011) described the adverse effects of unmanaged impostorism, such as anxiety, overpreparing and overworking, a lack of presence and active listening, and ineffective leadership. Stress can also decrease our interest in speaking up and pursuing positions of greater responsibility, while others may lower their expectations of us. It's essential to recognize these feelings as normal and address them by seeking support from trusted colleagues, mentors, or mental health professionals. By doing so, we can develop the resilience and confidence needed to achieve our goals and reach our full potential.

It's interesting to know that Imposter syndrome is often associated with anxiety, elevated levels of stress, lack of confidence, self-doubt, fear, insecurity, incompetence, unworthiness, and depression (Gill, 2020). Those who experience it find it difficult to accept praise, recognition, or positive feedback for their accomplishments and tend to focus only on the negative (Haong, 2013). There are currently no therapeutic cognitive interventions to treat individuals with IS. \ Cader et al. (2021) suggests screening for depression and anxiety may be necessary as IS often coexists with other mental health illnesses. According to Cader et al (2021) and Robinson-Walker (2011), some strategies to mitigate the effects of IS include:

1. Always be kind to yourself. 
2. Be conscious of your thoughts. Work diligently to change your mindset.  
3. Let go of the need to be perfect.
4. Leave your comfort zone. Don't let the fear of failure keep you from new experiences. 
5. Find a mentor or life coach. 
6. Celebrate your successes, no matter how small. 
7. Know your authentic self. Make a realistic list of your strengths.  
8. Have your list validated by your mentor.  
9. Accept that no one knows everything. 
10. Know the signs and focus only on the facts.  

Self-doubt can be a natural part of the growth process, as it can motivate us to improve and strive for better results. It's essential to recognize our imperfections and celebrate our successes, as both are part of the journey toward achieving our goals. Accepting the things we cannot change, being courageous enough to change the things we can, and being wise enough to know the difference is an excellent approach to live by. It helps us focus on what we can control and let go of what we can't, allowing us to move forward with confidence.

References 

Cader, F. A., Gupta, A., Han, J. K., Ibrahim, N. E., Lundberg, G. P., Mohamed, A., Singh, T. (2021). How feeling like an imposter can impede your success. JACC: Case Reports, 3 (2), 347–49. doi: 10.1016/j.jaccas.2021.01.003. 

Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241–247. https://doi.org/10.1037/h0086006 

Hoang, Q. (2013). The impostor phenomenon: Overcoming internalized barriers and recognizing achievements. The Vermont Connection, 34(1). https://scholarworks.uvm.edu/tvc/vol34/iss1/6 

LaDonna, K. A., Ginsburg, S., & Watling, C. (2018). "Rising to the level of your incompetence": What physicians' self-assessment of their performance reveals about the imposter syndrome in medicine. Academic Medicine, 93(5), 763–768. https://doi.org/10.1097/ACM.0000000000002046 

Robinson-Walker, C. (2011). The imposter syndrome. Nurse Leader, 9(4), 12–13. https://doi.org/10.1016/j.mnl.2011.05.003 

Sakulku, J., & Alexander, J. (2011). The impostor phenomenon. The Journal of Behavioral Science, 6(1), 75–97. https://doi.org/10.14456/ijbs.2011.6 

Young, V. (n.d.). The 5 types of impostors: – Impostor syndrome.  https://impostorsyndrome.com/5-types-of-impostors/ 

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An earlier version of this article was shared in March 2021