Garland struggled in her personal life from an early age. The pressures of early stardom affected her physical and mental health from the time she was a teenager; her self-image was influenced by constant criticism from film executives who believed that she was physically unattractive and who manipulated her onscreen physical appearance. Throughout her adulthood she was plagued by alcohol and substance use disorders, as well as financial instability, often owing hundreds of thousands of dollars in back taxes. Her lifelong struggle with substance use disorder ultimately led to her death in London from an accidental barbiturate overdose at age 47.