I know Bipolar and Schizoaffective are often considered progressive, but have you seen cases where the symptoms weren't progressing, just the patient became less able to mask them?

I have been diagnosed with schizoaffective-bipolar disorder. I have always been "high functioning" - I worked full time in a professional job while completing another graduate degree right after having my first child. That kind of high functioning.

However, I'm approaching forty and it seems like even though my symptoms are pretty much the same as they always have been, I have less capacity to cope with them. I had my first hospitalization at 32 and have had a few long ones since. I still work full time but I can't do nearly as much as I used to and I fear full time work will be too much soon - and I am one of those weird people who love working!

I keep hearing about the illness progressing, but I don't feel like that has been the issue for me. Instead I just feel like I can no longer manage my behavior and moods in a way that keeps it well hidden from people around me. I have better strategies now than I did in my twenties, thanks to great access to therapy and medical care - so shouldn't I be better at masking my issues?

So my question is whether you have observed this as a reoccurring pattern in your patient population?