I usually think that they are just trying to be nice and feel bad for me or something. I usually don’t have any positive feelings when praised, I just think nothing of it and believe I don’t deserve it, and if they really knew me, they wouldn’t be saying anything nice about me.
Very much this

The exception with me though, is I don't think nothing of it (though it depends who is saying it, and what's being said) but I'll feel uncomfortable or even guilty, because I feel if they really knew me they wouldn't be saying anything nice about me...Almost like I've been unintentionally decieving them, and then the next logical step is to try and set them straight and argue the point

and then there's the further problem that if their intention is good, and they're trying to raise my self-esteem or make me feel better or something, then how can I really trust what they're saying in future to be their honest opinion of me if they're sugar coating things to that extent?
It's basically a defense mechanism against a trojan horse. If I accept the kind gift, I have to live with the fact that my sulking, frustration, and negatively skewed view of myself is false and irrational, and that I am ultimately at fault. It's not easy to accept that when someone does compliment you, so it's easier to take it negatively and prevent any further ego damage.
Yes...I think that might be part of the problem.
Additionally there's the feeling that even if this person's compliment was both genuine and accurate, and that contrary to my beliefs they actually had seen me for who I am and liked me anyway...that prospect is scary as it would just make eventual rejection more crushing.
(Though I think regarding the conflict between how you see yourself and how others see you...what they see, even if it's not how you see yourself, isn't neccesarily untrue or invalid. just difficult to accept as 'the truth' because there isn't really 'a truth' it's just perception...that said I think how you see yourself influences how others see you, which in turn influences how you see yourself, so there's a sort of negative feedback loop there as well...)
(Or, before I straightened, "I like your hair, but why don't you ever straighten it?") I don't see that person as evil or anything, I just feel hurt and I wonder how awful my natural hair must have looked if the person had to say it like that... But I'm pretty paranoid, so my definition of a backhanded compliment is pretty broad.
I've done this before...
I cut and dyed my hair and the reaction from someone where I used to work was something along the lines of "what a transformation! why didn't you do that before?" which made me think...great...what must I have looked like before then, that 'transforming' from that obvious monster is such a good thing

I think that would be the real difference between compliment/insult...in terms of intention. In realising that the intention they meant to convey, and the meaning you took from it are different. I do know a proper insult when it comes up and slaps me in the face though

It's a bit of a double-standard though, because any compliments I give are very rare and awkward, or backhanded themselves. I don't like to outwardly and obviously show people I care about that I care about them, for some reason. So I'd express that through jokey insults. Though if they take my jokey insult as an actual insult, I get hurt/sad/frustrated over the misunderstanding

(I just remembered that once at school I was singing under my breath, I don't do that much anymore but I used to. A girl who was extrovert and popular and brash suddenly demmanded "who's that singing?!" and I thought, uh oh, now I'm for it, and sort of went "er. that was me. sorry." she said "don't be. you have a nice voice." I said "nah, not really." she said "learn to take a compliment." Still working on it
