I accepted my job as chair of the department of pathology at the University of Arkansas before I turned 40, though I didn’t start until after my birthday. I don’t know if I was the youngest chair in the country, but I think I was the only one with a car seat and a spare diaper in my purse. My memories of those first few months are still vivid, even nine years later. “What am I doing here?” I would wonder, “I don’t belong at this table,” I would think; “they made a mistake picking me,” I would lament. In retrospect, the ingredients for this voice were a small dose of self-protection and a larger dose of impostor syndrome.

Impostor syndrome, or impostor phenomenon, was first described in 1978 by Pauline Clance and Suzanne Imes. My simple definition is that impostor syndrome is pervasive self-under-appreciation. In other words, it arises when someone does not recognize, appreciate, and value their own talents and skills. Impostor syndrome can be blamed when other people think you are pretty awesome, and you just can’t see this awesomeness in yourself. It shows up as a smoldering feeling of self-doubt, even when you’ve thought through every angle. It lurks behind the worry that someone will eventually discover that you just aren’t as good as they think you are.

One thing I have learned about impostor syndrome is that it isn’t constant or consistent over time. One moment, you can be feeling strong and capable, and the next moment, you might be doubting every action. In some ways, impostor syndrome is like an auto-immune disease—it waxes and wanes, it flares up in response to certain triggers, and it can only be adequately controlled with diligence and careful attention.

People always wonder where impostor syndrome comes from. As a coach, I am much more interested in talking about helping people overcome it than discovering its roots. One thing I am interested in, however, is what sustains impostor syndrome over time?

For yourself, you might ask, “What manure is being piled on my garden of thistles, and what is fertilizing my impostor tendencies?” Part of that carefully honed mix of manure comes from inside, where impostor syndrome lives, but part of it comes from the outside world, where impostor syndrome thrives. Although I do workshops and talks on the internal drivers, it is also critical to think about the external drivers.

Some forms of discrimination and bias are subtle and quiet—often called “microaggressions” or “microinequities.” A microaggression can be defined as “indirect, subtle, or unintentional discrimination against a member of a marginalized group.” We are finally beginning to recognize how microaggressions and microinequities contribute to reinforcing and growing impostor tendencies. In a world where small inequities are pervasive and constant, there is little doubt they can easily become internalized as some kind of version of our truth. Think about the medical student that I quoted in my book on impostor syndrome:

When I was a medical student, early on in my clinical years, I was on a surgery rotation. The team included me, and all men: a male resident, fellow, and attending. I felt like an outsider, using the other locker room, and not part of their usual banter. One morning, the resident asked me to draw some labs on a patient right before rounds, so I was a few minutes late. The fellow glared at me and asked, “Were you just getting some extra beauty rest, or doing your makeup?” I know I turned bright red and didn’t even know what to say. I still remember how embarrassing that moment was.

Microaggressions against women are relatively common in medicine, and it appears that women are especially attuned to them. Themes include sexism, pregnancy, and child-care bias, underestimating abilities, sexually inappropriate comments, relegation to mundane tasks, and exclusion and marginalization. What professional woman hasn’t been asked inappropriately to get someone coffee, make copies, or take minutes? And what professional woman hasn’t been underestimated and discounted because she is married or has children—or even because she doesn’t? What professional woman hasn’t been told she should act more like a man, or act more like a lady? And these are probably orders of magnitude higher for women of color.

After working with many women physicians who suffer from impostor syndrome, I am tuned into hearing and noticing the impact microaggressions have. If you already experience self-doubt and your self-confidence is already low, hearing microaggressions is like stepping on a thousand tiny thumbtacks—each one might be just an annoyance but, taken together, they will probably hurt. And, this is one way that impostor syndrome continues to thrive.

I hope you are horrified and thinking, “What can I do to stop this cycle?”  First, start noticing accidental and unintentional microaggressions, whether they are your own or those of others. Second, find your own personal way to gently and kindly label them, maybe out loud and in public, or maybe offline. Third, when you receive a tiny cutting blow from a microaggression, practicing letting it drop onto the floor, instead of absorbing it as it makes contact.

Impostor syndrome is pervasive, and it is damaging—and we all probably have a part in its cultivation in our society. We can all have a part in its demise.

Jennifer Hunt is a pathologist and can be reached at her self-titled site, Jennifer Hunt, MD. She is the author of Unlocking Your Authentic Self: Overcoming Impostor Syndrome, Enhancing Self-confidence, and Banishing Self-doubt.

Image credit: Shutterstock.com