Touhou deities are humanized but at their core they're concepts and objects and their one goal is to provide services in exchange for worship so that they can keep the part that makes them human-like and with that, gives them a body and autonomy. There are some deities that can take tangible forms without (much) worship and that's because they embody things that exist regardless of humans. They are the fairies.
Okina embodies things that are (mostly) very strictly tied to human culture and psychology: Noh theatre, outcasts, the disabled, mysteries, the unknown, obstacles, thresholds, the Big Dipper constellation. In fact they're tied to humanity in the sense that many of these concepts are repulsive or simply hard to understand or relate to them.
This creates a contradition for and in her I feel. She's many times the enemy or at least a challenger to humanity and yet she still depends on their worship. In many regards she owns this contradiction though. She isn't like Kanako, she's trying to get worship (mostly) by intimidating people, which is both and old-school way of doing so and a youkai-like way.
I think despite what ZUN says, Okina IS disabled, just not in a way humans are. I think she lives in a contradiction where her true home, where she can truly rest and heal and belong is the Land of the Back Door, because the unseen world is a place away from human understanding and comfort. But since she only exists as long as humans are close enough to fear the unknown and (attempt to) solve mysteries, she must come to the forward facing world more times than what's "healthy" or "comfortable" for her.
This probably ties her sense of self to the forward facing world and her function to humans. This also probably happens to every touhou deity, but I feel like it's especially a central issue for Okina, someone who has to do twice the work since she can only truly and healthily exist in a place away from human perception, despite needing human perception to exist.
I think for that reason she especially de-personifies herself. She probably has a rich inner life that no one else can comprehend, but she has to translate that into a language that lacks so many directly translatable words. So she chooses theatre and roles to put herself into. The benevolent old man, the wrathful deity, the guardian of the Pure Land, the patron of outcasts. In reality she's all, more and none of those at the same time and by nature she will never be able to properly convey that to anyone.
And I do think that makes her lonely in her own way. Everything in the univere is trying to find more like itself, so knowing that she's one of a kind, Okina must probably feel both a sense of superiority and a sense of loneliness, and it manifests in the way she's looking for faith (see the scene where she offers to change the seasons for Marisa in Grimoire of Usami).
All people see is a creepy if not desperate deity.
The one person who comes close to understanding her is Yuuma, who she can bond with over their shared hunger.
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