passive-aggressive narcissists don't always know or realize that they are passive-aggressive narcissist. Even if they go to therapy, therapists may not be able to diagnose or see them as passive-aggressive narcissists since they are the way they are, they project a certain behavior or self toward the therapist, not necessarily with intentions to manipulate them but because they are passive aggressive narcissists. They don't see or understand how they are acting either, and don't see reality/and they are nasty human beings but don't really see themselves as such. NOT ALL but based on the passive-aggressive narcissist in my life that I observed.