Maladaptive Perfectionism, Impostorism, and Cognitive Distortions: Threats to the Mental Health of Pre-clinical Medical Students

Acad Psychiatry. 2019 Aug;43(4):381-385. doi: 10.1007/s40596-019-01031-z. Epub 2019 Feb 6.


Objective: While medical student wellness has been a subject of recent study and discussion, current efforts may fail to address possible underlying, harmful cognitive distortions regarding academic performance. The authors sought to examine dysfunctional thoughts (maladaptive perfectionism, impostor phenomenon) and negative feelings (shame, embarrassment, inadequacy) that may contribute to poor mental health in pre-clinical medical students.

Methods: A survey was administered to first-year medical students at Saint Louis University that included assessments for maladaptive perfectionism, impostor phenomenon, depression, and anxiety, as well as questions about feelings of shame, embarrassment, inadequacy, comparison, and self-worth.

Results: A total of 169 students (93%) participated. Students who met criteria for maladaptive perfectionism were significantly more likely to report greater feelings of shame/embarrassment and inadequacy (P < 0.001) than their peers who did not; similar associations were observed in students who reported high/intense levels of impostor phenomenon (P < 0.001). Furthermore, students who reported feelings of shame/embarrassment or inadequacy were significantly more likely to report moderate/severe levels of depression symptoms (P < 0.001) and moderate/high levels of anxiety symptoms (P = 0.001) relative to students who did not report these negative feelings.

Conclusions: These preliminary data support a model for how negative thoughts may lead to negative emotions, and depression and anxiety in medical students. The authors propose strategies for preventive interventions in medical school beginning in orientation. Further research is needed to develop targeted interventions to promote student mental health through reduction of cognitive distortions and negative feelings of shame, embarrassment, and inadequacy.

Keywords: Learner well-being; Medical education; Perfectionism; Shame.

MeSH terms

  • Academic Success*
  • Adult
  • Anxiety / psychology*
  • Depression / psychology*
  • Education, Medical, Undergraduate
  • Humans
  • Mental Health*
  • Perfectionism*
  • Stress, Psychological / psychology
  • Students, Medical / psychology*
  • Surveys and Questionnaires