Body dysmorphic disorder, a preoccupation with flaws in appearance that others barely notice or cannot see, often accompanies obsessive-compulsive disorder (OCD). Researchers from Rutgers University, Yeshiva University, Oregon State University, and Weill Cornell Medicine analyzed 1,475 participants with OCD from the NIMH-funded Genomic Psychiatry Cohort. Nearly half also screened positive for probable body dysmorphic disorder. That group reported higher lifetime rates of all four substance categories studied, roughly double the rate of illicit drug use, greater alcohol and tobacco severity, and more drinking to calm nerves. Because the study is cross-sectional, it cannot say which came first. The authors urge clinicians to screen for both.