They aren't comfortable with it. They're uncomfortable the whole time. The whole "fake it til you make it" stance means they're going to fake it for the rest of their lives. Then when they're at the end of their life (around age 45-55) they may realize that while they "faked it" and, they never made it. They also realize that all the confidence and "loving yourself" in the world can't bring them actual joy in life, especially when they die 40 years ahead of their time.