She has had what she calls a Wizard of Oz life: 'Oldham was a grey factory town. Manchester was 15 miles away and felt like another world. A lot of the mills and factories were abandoned or closing down. I didn't know I was going to model, but I knew I was going to do anything to get out. For my sanity.' Her father was a joiner, her mother a housewife, and they divorced when Karen and her twin sister Kate were seven. 'As a teenager, I didn't really have a lot of people who I looked at and thought, "Wow, I want to be you."'
The Madchester music scene was something her two older half-brothers were part of, but 'by the time I went to The Hacienda, the glory days were distant memories and the casualties were building up'. Aged 15, she watched PJ Harvey's Glam-Gothic video for 'Down By the Water'. She went straight out and bought the album, which she listened to on her Walkman under the covers at night. She kept her ambitions quiet 'because I didn't want to challenge anybody and have them come down on me like a ton of bricks and crush my dreams'. The school careers adviser wasn't much help. 'I told them all my grand ideas and they said, "That's not going to happen." ' Since she wanted to travel, they suggested she should become an air hostess. She hoots with laughter. 'Which was the last thing I wanted to do!'
From an early age, she had problems with food, suffering from anorexia and bulimia, which she dates back to her parents' divorce. 'I couldn't express what I was feeling so I acted it out through food.' At school she was considered too skinny. In fact, her album's title, The Ghost Who Walks, was, she tells me, 'one of my nicer nicknames at school'. During athletics, kids used to shout 'starving whippet' from the sidelines; she bought 'get fat' cookery books and tried to build herself up. Then, when she went to Manchester on work experience, her skinny frame became an asset: she was recruited by a Hugo Boss modelling scout.
'The day I left school, I was out. I was 16. I remember walking out the door and thinking, "I am never coming back." And I never did.' Neither did her twin, who's a model and film-maker in New York. She's smaller in stature than Karen, and still has the mousy brown hair they were born with. They keep in touch, doing work-out classes together via Skype. 'She's brilliant and really successful,' says Karen.
Karen was doing well as an ingénue model, with a Paris Vogue cover and a contract promoting Clinique Happy, until she met the photographer Steven Meisel. He convinced her to shave her eyebrows and dye her hair an unholy red, and an unconventional icon was born. In 1997, she was on the cover of The Face, Vogue Italia and Elle, and as 2000 approached, her unreal, futuristic look was very much of the moment. In France she was called 'Le Freak (très chic)' and Karl Lagerfeld made her the face of Chanel, dubbing her 'a beauty for the new millennium'.
In her late teens, she filled out a bit. This meant her size, again, was at fault. A stylist told her to lose weight; Dolce and Gabbana turned her away from their catwalk in Milan because she couldn't fit into samples. She publicly denounced the 'power trips' of weight fascists in fashion. Secretly, while living in New York, she was practising rituals of starvation, vomiting and laxative abuse. It wasn't simply a way of keeping her job but the expression of a deeper psychic wound. 'I used my job to justify my eating disorder,' she has said in the past. 'If you're really good at numbing your hunger, you can mask your emotional pain as well.' Her wake-up call came in 2000 when her boyfriend of two years died of a heroin overdose, and she sought help from a therapist. Today, she looks healthy and beautiful, and she doesn't want to talk about food issues, although you sense these things are never straightforward for her. She checks that her falafel and hummus are dairy-free, saying passionately, 'I do not drink milk.'