The Women's 400 metre individual medley competition of the 2022 FINA World Swimming Championships (25 m) was held on 17 December 2022.

Records Prior to the competition, the existing world and championship records were as follows.

Results Heats The heats were started at 11:47.

Rank Heat Lane Name Nationality Time Notes 1 4 7 Leah Smith 4:30.93 Q 2 4 6 Sara Franceschi 4:31.01 Q 3 3 7 Waka Kobori 4:31.19 Q 4 3 3 Zsuzsanna Jakabos 4:31.36 Q 5 4 3 Hali Flickinger 4:31.61 Q 6 3 5 Ilaria Cusinato 4:32.94 Q 7 4 4 Tessa Cieplucha 4:33.58 Q 8 4 1 Cyrielle Duhamel 4:34.03 Q 9 4 5 Abbie Wood 4:34.45 10 3 2 Kayla Hardy 4:34.77 11 3 1 Emilie Muir 4:35.52 12 2 2 Mya Rasmussen 4:36.08 13 2 3 Deniz Ertan 4:38.11 14 2 4 Dakota Tucker 4:40.01 15 3 8 Nikoleta Trníková 4:40.09 16 4 2 Ayami Suzuzki 4:40.95 17 2 7 Iman Avdić 4:42.56 NR 18 2 6 Portia Brown 4:44.68 19 1 3 Chen Szu-an 4:44.97 20 1 4 Ng Lai Wa 4:45.62 21 3 6 Ge Chutong 4:46.59 22 1 5 Lucero Mejía 4:49.99 NR 2 5 Anja Crevar 3 4 Sydney Pickrem 4 8 Gabrielle Roncatto

Final The final was held at 20:40.

Rank Lane Name Nationality Time Notes 2 Hali Flickinger 4:26.51 5 Sara Franceschi 4:28.58 3 Waka Kobori 4:29.03 4 4 Leah Smith 4:29.18 5 6 Zsuzsanna Jakabos 4:32.10 6 8 Cyrielle Duhamel 4:32.40 7 7 Ilaria Cusinato 4:32.68 1 Tessa Cieplucha

References