One of the problems with being a people pleaser is that you are in a constant state of low grade dishonesty.
Afraid to tell your truth -- often completely out-of-touch with what your truth even is -- every interaction is based on a reflexive fear of any kind of conflict whatsoever.
We may tell ourselves we're nice, or that we mean well, but the truth is often that we are simply afraid to play it any differently. In fact for some of us, we actually lose the ability to.
(It's not courtesy, tact or diplomacy if you're afraid to be clear. Or, conversely, if you have to work yourself up into a hysterical rage to finally be honest, and then spend the next 24 hours apologizing and passive/aggressively asking everyone if you're a terrible person, just so they can reassure you that you're not, you are equally trapped in fear.)
As a people pleaser, at the end of the day I have no integrity.
And there is, for lack of a better word, a psychic price one pays for that.