Snodderly, I believe that you are right that either at some point, or some level of their thinking they come to know the damage they have caused. I don't think this is the case at the outset. But I totally agree that pride is a big part of their remaining stuck. The sort of pride that also prevents them from asking for the help that they need.
They have spent such a long time trying to convince themselves and anyone else who will listen that they are right, and the world is wrong, that if and when it begins to dawn on them that their world is far from OK, they dive behind the mask.
Masks are a big part of MLC. Hiding and pretending. But sadly they are too old for this game.