I think he was probably always that. But his recent behaviour seems reckless.
I'm not an expert on mental health or neuro diversity, but speaking from personal experience I feel I struggle outside of a stable environment or one I feel I can control easily. I can have problems regulating my emotional responses, especially to unexpected negative situations. I can experience brain lock, dissociation or emotional outbursts (especially if I've been drinking on the latter).
Could be that doubling down is Musk's conditioned response or natural defense mechanism - it could literally be the only way he knows how to react. But he must have advisors or a support team. Then again, I guess they can't just snatch his phone out of his hands. He's turned almost the entire Twitterverse against him.
It's often the same with such people. The more control they try to exercise, the less they actually have. Musk bought the internet equivalent of the Black Lagoon, and now he can't handle that it's full of creatures.