For me things feel very much hard wired too. Having had dysthymia with recurring major depression, eating disorders, anxiety etc, since my childhood, they feel like parts of my personality. I've had lots of therapy, but ultimately I'm too damaged to let go of my destructive defences.
I feel insecure, ashamed and guilty if I'm not perfect, or as close to that as I can be. Being imperfect, i.e. the fat, unsuccessful slob I am, makes me vulnerable. When I am slim, polished and doing well in my pursuits, I feel like nobody can hurt me, as they don't have anything to criticise or reject me about.
I wish I could just accept myself and be happy, but I am too scared. Better to avoid others and beat myself up about things pre-emptively before others do, as I'd hate to be unprepared for criticism or rejection. I somehow also believe that I have to shame and pressurise myself into action about my flaws. Otherwise I will always be a fat, underachieving slob.