I have most of these problems quite often. I've been thinking I might need something for paranoia, but it seems to subside a little when I stop trying to pass en femme. Even around people I know very well, I feel that if I don't pass well enough, they'll just see me and judge me to no avail, so I stopped trying for the moment. I've also noticed the same thing after simply being open and coming out. As you've said, it might be delusion.
The trick for me was to realize that people close to you can very well hurt you, and not to be blindsided by it, but at the same time accept that they probably won't. I let them know that if they do, they don't deserve that position in my life, and will be cast out and left as nothing but a meaningless blip in my past. Problem solved.
It's not everyone's preferred approach, but it works for me; I prefer invulnerability. I guess it could be described as acceptance of insecurity that won't go away, but coming to terms with it and emotionally shielding against or preparing to evade anything that you perceive could happen. It's tricky, though, like a mental puzzle; there has to be a balance of walls and bridges in all the right places to be safe but happy. I hope you figure it out in a way that makes you happy.
