They’re basically all related to having deficient or broken reward reactions, the primary emotional reaction to dopamine. Willpower is hard to achieve if you expect to be disappointed. Pretending is a social necessity to avoid disappointing others, and the rejection that you could expect from that. Failing to muster willpower or follow through manifests that disappointment. Emotions swing when the little burst of reward that might sustain someone else is gone, and then you scrutinize your ability to even appreciate what you do have. Maintaining friendships is hard if you need to tend to yourself, and then again if you feel guilty for neglecting your friends. It compounds if your guilt makes it harder to reach out after some time being a “bad” friend. People questioning your reality makes you question it too. Now it’s your fault, in your mind. But if you’re incapable of fixing it you’re just... at odds with everything. If you are medicated... those other waking hours you’re dealing with all of this not only without the chemical benefits but with the crash that comes after which can amplify everything else.