With me there is a definite link. I was raised (intentionally or not) to value appearance as the most important thing. I had the impression that nothing else matters if you don't look good. And I certainly did not look good. As a child, I had terribly bucked teeth until they were fixed, and I matured early which meant I was very different from my peers. I was wearing a size 34A bra to fourth grade, for example, and already had hair under my arms that I was not allowed to shave. As I continued to mature, I developed visible facial hair (I am a woman) and a unibrow, but I was not permitted to take care of these problems. On top of all this, my family was so poor that bathing was limited to conserve on hot water and soap, and clothes were out of style at best, rags at worst. And the most frustrating of all is that I am built to be larger than average, even at my healthiest weight, since my frame is stocky and muscular. No matter what, a St. Bernard is never going to be a sleek, slim Greyhound, because a St. Bernard isn't built that way. But, no matter how good I might look in other aspects (straightened teeth, long flowing healthy hair, good skin) my weight disqualified me from considering myself beautiful.

So, in a mindset that valued appearance above all else, I was made to believe that I looked like Quasimodo. There is no way I can separate that from my self-esteem, since any strengths I had (intelligence, for example) were dismissed and didn't count, so I was not allowed to feel good about myself for those things.