Most of us (including myself) have this belief that he knows exactly what he is doing, it could be the case he doesn't and that is the scary thing about all this. If he has no idea wnat he is doing, that could actually be very dangerous.
I don't think anyone believes he doesn't know what he's doing, the key thing is he doesn't appear to see anything wrong with it or feel any remorse, like he lacks morals, not that he's broken any moral code. i.e. he's amoral as well as immoral.
All he seems to feel is anger and resentment if he's be inconvenienced, challenged or caught doing something. Nothing todo with shame or remorse for the act itself, just the consequences of people's reactions to it. He's angry at losing patreons and the money, and doesn't see anything really wrong with what he's done.
I can only speak for myself, but I suspect most people would be similar: not only would we never even think of visiting prostitutes in the first place but if we had, having it come out and telling the world about it would be so shame inducing I don't think I'd ever leave my house, let alone talk about it to the world on YouTube.
He has to have no shame whatsoever to do that. He can't have any real sense of the hurt he's caused his wife and the damage it does to his kids, because if someone did, how would they keep at it so regularly for 4+ years?
Instead, we get an act. He knows what a normal person is supposed to react like, so we get a poorly-acted version of it. But it's off, slightly odd, because the real feelings don't appear to be there.
This appears to have been his entire life. Living as a fraud, knowing how he's meant to behave but never believing it, never living up to it, and then always excusing what he's done and seeing no shame for anything. His book is hardly the work of someone who sounds "repressed" in any way, it sounds more like someone with no controls over their behavior.
For most people, the potential shame or embarrassment of being immoral helps temper their behavior. He doesn't appear to have that switch.
I don't know if it's common for that to be a factor in men seeing women as objects to be used. I suspect there is some element involved as you have to no care about other people's feelings as most as you don't care about their opinions of you.