The Carpenters were one of the biggest-selling American musical acts of all time. Between 1970 and 1984 brother and sister Richard and Karen Carpenter had 17 top 20 hits, including "Goodbye to Love", "Yesterday Once More", "Close to You" and "Rainy Days and Mondays". They notched up 10 gold singles, nine gold albums, one multi-platinum album and three Grammy awards. Karen's velvety voice and Richard's airy melodies and meticulously crafted arrangements stood in direct contrast to the louder, wilder rock dominating the rest of the charts at the time, yet they became immensely popular, selling more than 100m records.

Richard was the musical driving force but it was Karen's effortless voice that lay behind the Carpenters' hits. Promoted from behind the drums to star vocalist, she became one of the decade's most instantly recognisable female singers.

But there was a tragic discrepancy between her public and private selves. Offstage, away from the spotlight, she felt desperately unloved by her mother, Agnes, who favoured Richard, and struggled with low self-esteem, eventually developing anorexia nervosa from which she never recovered. She died at the age of 32.

In 1996 journalist Rob Hoerburger powerfully summed up Karen Carpenter's tribulations in a New York Times Magazine feature: "If anorexia has classically been defined as a young woman's struggle for control, then Karen was a prime candidate, for the two things she valued most in the world – her voice and her mother's love – were exclusively the property of her brother Richard. At least she would control the size of her own body." And control it she did. By September 1975 her weight fell to 6st 7lb (41kg).

Karen's quest to be thin seems to have begun innocently enough just after high school graduation when she started the Stillman water diet. Although she was never obese, she was what most would consider a chubby 17-year-old at 10st 5lb. (She was 5ft 4in tall.) She levelled off at around 8st 8lb and maintained her weight by eating sensibly but not starving herself. Even so, eating while on tour was problematic for Karen, as she described in 1973: "When you're on the road it's hard to eat. Period. On top of that, it's rough to eat well. We don't like to eat before a show because I can't stand singing with a full stomach… You never get to dinner until, like, midnight, and if you eat heavy you're not going to sleep, and you're going to be a balloon."

Karen was shocked when she saw photos from an August 1973 Lake Tahoe concert where an unflattering outfit accentuated her paunch. She hired a personal trainer, who made visits to her home and recommended a diet low in calories but high in carbohydrates. Instead of slimming down as she had hoped, Karen started to put on muscle and bulk up. Watching the Carpenters on a Bob Hope television special that autumn, she remarked that she had put on some extra weight. Richard agreed she looked a bit heavier. She was discouraged and vowed she was going to "do something about it". She fired her trainer, and immediately set out on a mission to shed the unwanted pounds on her own. She purchased a hip cycle, which she used each morning on her bed, and because it was portable the equipment was packed and taken with her on tour.

"She lost around 20lb and she looked fabulous," recalls Carole Curb, the sister of Karen's then boyfriend, record executive Mike Curb. "She weighed 110lb [7st 12lb] or so, and looked amazing… If she'd been able to stop there then life would have been beautiful. A lot of us girls in that era went through moments of that. Everybody wanted to be Twiggy. Karen got carried away. She just couldn't stop."

Having witnessed Karen's meticulous routine of counting calories and planning food intake for every meal, Richard complimented her initial weight loss during a break from recording as the two dined at the Au Petit Café, a favourite French bistro on Vine Street near the A&M studios. "You look great," he told her.

"Well, I'm just going to get down to around 105."

"A hundred and five? You look great now."

Karen's response worried Richard. In fact, this was the first time he paused to consider she might be taking the diet too far. Friends and family began to notice extreme changes in Karen's eating habits, despite her attempts at subtlety. She rearranged and pushed her food around the plate with a fork as she talked, which gave the appearance of eating. Another of her strategies involved offering samples of her food to others around the table. She would rave on about her delicious meal and then insist that everyone try it for themselves. "Here, you have some," she would say as she enthusiastically scooped heaps on to others' plates. "Would you like to taste this?" By the time dinner was over, Karen's plate was clean but she had dispersed her entire meal to everyone else. Her mother, Agnes, caught on to this ploy and began to do the same in return. "Well, this is good, too," she would say as she put more food on to her daughter's plate. This infuriated Karen, who realised she would have to find other ways to avoid eating.

By the time Karen's weight dropped to 6st 6lb, she looked for ways to disguise the weight loss, especially around those she knew would make comments or pester her to eat more. She began to layer her clothing, a strategy her agent Sherwin Bash noticed in the early part of 1975. "She would start with a long-sleeved shirt and then put a blouse over that," he explains, "and a sweater over that and a jacket over that… With all of it you had no idea of what she had become."

But family friend Evelyn Wallace was shocked when she caught a glimpse of Karen's gaunt figure as she sunbathed topless in the back garden of the Carpenters' home in Downey, California, one afternoon. "They put this screen around her so nobody else could see her," Wallace explains. "She loved to go lay out in the sunshine. I don't know whether it was to get a tan or get away from her mother. Anyhow, I happened to go out to the kitchen for something and I saw her out there. She just had on her little bathing suit shorts. You couldn't tell whether it was a girl or a boy. She had absolutely no breasts."

Karen's new slim figure required that she purchase a new stage wardrobe, and she opted for a number of low-cut silky gowns, some strapless or even backless. Bash was horrified to see her bony shoulders and ribs. Even her hip bones were visible through the thin layers of fabric. He asked Karen to rethink the wardrobe choices before going on stage. "I talked her into putting a jacket on over the bare back and bare arms," he said, "but the audience saw it."

There was often a collective gasp from the audience when Karen would take the stage. In fact, after a few shows, Bash was approached by concerned fans who knew something was terribly wrong but assumed she had cancer or some other disease. Even critics took note of her gaunt appearance. A review for Variety praised Karen's emergence from behind the drums to centre stage but commented on her deteriorating appearance. "She is terribly thin, almost a wraith, and should be gowned more becomingly."

No one really understood why Karen wasn't eating. To those around her the solution seemed simple: eat. "Anorexia nervosa was so new that I didn't even know how to pronounce it until 1980," band member John Bettis said. "From the outside the solution looks so simple. All a person has to do is eat. So we were constantly trying to shove food at Karen… My opinion about anorexia is it's an attempt to have control – something in your life you can do something about, that you can regiment. That just got out of control with her."

Band members witnessed her exhaustion. She was lying down between shows, something she had rarely, if ever, done before. They were shocked to see how she could be flat on her back one minute and on stage singing the next. Even when doing back-to-back shows, Karen displayed "a tremendous amount of nervous energy", said Bash. Unlike her parents, Bash had no qualms about confronting Karen on the issue of anorexia. "The fact that she was anorexic was discussed innumerable times… There was every attempt to get her to seek professional help, but I believe her family was the kind of family where the mother would say, 'We can take care of ourselves. We don't need to have someone help. This is a family matter.'"

When Karen dieted, or "overdieted", Bash explains, there was a rush of attention from the family, especially Agnes. "Karen had never had attention from Agnes before – her mother doted exclusively on Richard – so she liked it. The experts say that one of the things that seems to drive young girls to overdiet is that they were oftentimes the kids that never got attention. It's a way of getting the love from their family that they never got before."

By the autumn of 1975 Karen's failing health could no longer be ignored. In addition to her skeletal appearance, she was mentally and physically exhausted. Although she made it through a series of shows in LasVegas without a major incident, upon returning to Los Angeles she checked into Cedars-Sinai Medical Centre, where she spent five days while doctors ran tests. "She is suffering a severe case of physical and nervous exhaustion," said Dr Robert Koblin in a statement to the press. "She had a hectic four-week schedule lined up in Europe but I could not allow her to go through with it. In my opinion it would have been highly dangerous to her long-term health." Melody Maker reported that the Carpenters' tour would have been the highest-grossing tour in Britain and that approximately 150,000 people were set to see them during the planned 28-day European trek. Ticket sales for the 50 shows, which sold out in a matter of hours, were refunded. It was reported that the Carpenters may have easily lost upward of $250,000 due to the cancelled concerts.

Under Agnes Carpenter's close watch, Karen slept 14-16 hours a day. "My mother thought I was dead," she told biographer Ray Coleman. "I normally manage on four to six hours. It was obvious that for the past two years I'd been running on nervous energy." Her weight eventually climbed to 7st 6lb.

Over the next five years Karen continued to struggle with anorexia and bulimia nervosa. Meanwhile Richard Carpenter fought and won a battle with Quaalude addiction. Then in June 1980, after an unsuccessful attempt to launch a solo career, Karen announced her engagement to a property developer called Tom Burris.

Thirty-nine-year-old Tom Burris met a number of Karen's requirements in a potential husband. "He was very attractive, very nice, and he seemed very generous," said Carole Curb. Two months into their relationship, Burris told Karen he wanted to spend the rest of his life with her. The couple's plan for a year-long engagement was ditched when they announced in July their plans for an August ceremony. The push to be married alarmed Karen's friends. According to Karen 'Itchie' Ramone, Karen's friend and the wife of producer Phil Ramone, "That's when everybody's antennas went up." Days before the wedding rehearsal Burris dropped a bombshell: he had undergone a vasectomy prior to their meeting. Karen was dumbfounded. He offered to reverse the procedure but their chances at a family would be significantly lessened.

Karen felt betrayed. Burris had lied to her; he had withheld this information for the duration of their courtship and engagement, knowing full well that starting a family was at the top of Karen's list of priorities. This was a deal breaker. The wedding was off. Karen picked up the phone and called her mother. She cried to Agnes as she explained the deceit that left her with no choice but to cancel the ceremony. But Agnes told her she would do no such thing. Family and friends were travelling from all over the country to attend the event. Moreover, the wedding expenses had already cost what Agnes considered to be a small fortune. "The invitations have gone out. There are reporters and photographers coming. People magazine is going to be there. The wedding is on, and you will walk down that aisle. You made your bed, Karen," she told her. "Now you'll have to lay in it."

Most of Karen's family and friends had assumed Burris's lifestyle and net worth were comparable to her own. The expensive cars and other possessions gave him the appearance of a multimillionaire, but what others did not realise was that he was living well beyond his means.

"It wasn't long after they got married that he started asking her for money," recalls Evelyn Wallace. "He'd give her some excuse, and she'd give him the money. He'd ask for $35,000 and $50,000 at a time. Finally it got down to the point where all she had left was stocks and bonds."

As Itchie Ramone recalls, "Tom couldn't afford the houses, the cars, her wedding ring; he couldn't pay for anything." Karen began to share with friends her growing misgivings about Tom, not only concerning his finances but also his lack of feelings for her. He was often impatient, and she admitted being fearful when he would occasionally lose his temper. "He could be very cruel to her," says Itchie. But Karen's longing to be a mother proved to be stronger than her desire to leave her husband. At their house in Newport Beach Karen expressed to Burris her desire to get pregnant and start a family. His response was brutal. She was still crying hysterically when she called Itchie Ramone for support. Burris had told her he wouldn't even consider having children with her and called her "a bag of bones". According to Itchie, this marriage was "the straw that broke the camel's back. It was absolutely the worst thing that could have ever happened to her."

Friends suggested she and Burris seek marital counselling. Instead, the Carpenters prepared to leave for Europe and South America. Itchie went along to keep Karen company. In reality, however, according to Itchie, "Laxatives were her major companion. When we were in Paris we made quite a scene in a pharmacy across the street from our hotel about her needing to buy more laxatives. I suggested natural food groups that might relieve her 'constipation' but she always won those arguments."

Following a brief stop in Amsterdam, the Carpenters arrived at London's Heathrow airport on Wednesday, 21 October 1981. They made numerous promotional appearances while in London, both in person and on television. On Thursday they taped an interview for Nationwide, a popular news magazine on BBC television. Barely one minute into their visit, host Sue Lawley surprised Karen by casting light on her darkest secret. "There were rumours that you were suffering from the slimmer's disease anorexia nervosa," Lawley said. "Is that right?" "No, I was just pooped," Karen said with an intense frown. "I was tired out."

"You went down to about six stone in weight, I think, didn't you?" Lawley asked. "I have no idea what 'six stone in weight' is," Karen replied, becoming noticeably uncomfortable and increasingly agitated. She struggled to fake a laugh, rolling her eyes at the interviewer, who quickly converted the amount to approximately 84lbs. "No," she said, shaking her head adamantly. "No."

In actuality her weight was hovering around 5st 10lbs even then. The interviewer's continued efforts to pinpoint a reason for Karen's skeletal appearance prompted Richard to come to his sister's defence. "I don't really feel that we should be talking about the weight loss," he told Lawley. "Maybe it's better to take a pass on the whole thing. It's really not what we're here for."

"I am just asking you the questions people want to know the answers to," Lawley replied.

Returning to Los Angeles in November 1981, Karen filed for divorce. Leaving behind the pieces of her broken marriage, she set out on a year-long recovery mission, relocating to New York City's Regency Hotel in January 1982. Manager Jerry Weintraub arranged for Karen and Itchie Ramone to share a two-bedroom suite. Cherry O'Neill, the eldest daughter of singer Pat Boone who had herself recovered from anorexia, had recommended Karen consider coming to the northwest and seeing the doctor who helped her. But in Karen's world, one name was synonymous with anorexia treatment, and that name was Steven Levenkron. He was a psychotherapist specialising in eating disorders and his successful book The Best Little Girl in the World had become a highly acclaimed television movie, which aired in May 1981. Levenkron agreed to treat her. He received £100 for each hour-long session five days a week, totalling $2,000 a month. "I liked Levenkron, at least in the beginning," Itchie Ramone says. "No one really knew why someone would get the disorder or how to treat it, so we were really looking to him to 'save' her."

Arriving at Levenkron's office at 16 East Seventy-Ninth in Manhattan, Karen weighed in at an alarming 5st 8lb. A week into their daily sessions, Karen admitted to Levenkron she was taking a large number of laxative tablets – 80-90 Dulcolax a night. This did not surprise Levenkron. In fact, it was a common practice for many anorexics. "For quite some time, I was taking 60 laxatives at once," admits Cherry O'Neill. "Mainly because that was how many came in the box… I would ingest the entire contents so as not to leave any evidence."

What did stun Levenkron was Karen's next casual disclosure. She was also taking thyroid medication – 10 pills a day. He was shocked, especially when she explained that she had a normal thyroid. Realising she was using the medication to speed up her metabolism, Levenkron confiscated the pills. This was the first case of thyroid medication abuse he had seen in his dozen years in the field.

According to Levenkron's 1982 book, Treating and Overcoming Anorexia Nervosa, the patient must become totally dependent upon the therapist. Once the patient has transferred their dependence on to him, he tries to teach them how to create their own sense of identity, and he helps them disengage from their dependence on him with new behaviours, habits, and thought patterns.

Karen took advantage of the beautiful spring weather and began a new exercise routine – to and from her sessions with Levenkron – a brisk two-mile round-trip walk. This was yet another method to burn extra calories. Outwardly Karen seemed committed to the idea of therapy, but as evidenced by her daily walking regimen, she was not as committed to making actual changes that would result in real progress. "She was still walking a lot, and she was exercising," Carole Curb says. "And then she was into throwing up and taking pills that make you lose water-weight. Debilitating things like that."

Several months into his sessions with Karen, Levenkron began to suspect that she had fallen off the wagon. He invited the Carpenter parents and Richard to a 90-minute family therapy session at his office. "They did come to New York –finally," Itchie Ramone recalls, "and only after a lot of nudging. By then, Karen seemed to be starting to turn the corner a bit emotionally."

The stigma surrounding mental illness and a need for therapy was frightening for the family, especially Agnes, who felt Karen was simply going overboard as far as dieting was concerned. If only she would stop being so stubborn and just eat. Over the years the family tried every possible approach to get through to her and make her eat. "Everyone around her did everything that they could have humanly done," Richard said in 1993. "I tried everything – the heart-to-heart, the cajole, the holler… It can just make you crazy. Obviously it wasn't about to work, and I was upset."

Levenkron explained that the family's attempts to threaten or bribe Karen out of her behaviours would never make them go away. According to his book, "Failure of the family to understand this produces division within the family that in turn results in feelings of anger and guilt. The family atmosphere is chaotic, reinforcing the anorexic's belief that she and no one else knows what is best for her." Levenkron suggested to the family that Karen was in need of a more tactile, demonstrative kind of love. Karen cried uncontrollably during the meeting. She told them how sorry she was for having put them in a situation where they felt a need to defend her upbringing, and she went so far as to apologise for ruining their lives. "I think Karen really needs to hear that you love her," Levenkron told the family.

"Well, of course I love you," Richard told her unreservedly.

"Agnes?" The therapist tapped the mother's shoe with his own.

Rather than address her daughter, Agnes explained how she preferred to be called Mrs Carpenter. "Well, I'm from the north," she continued. "And we just don't do things that way."

"Agnes couldn't do it," says Itchie Ramone, who discussed the meeting with Karen and Levenkron after the family left. "She couldn't do it… In therapy you're basically stark naked. Then your own mother can't reach out to you? And the way she doted on Richard. Most children would try to dance as fast as they could to make their parents love them, but it was at that point that I think Karen decided it was time to take a step back."

After the meeting with Levenkron, Richard became angry with the treatment plan, which he thought to be worthless. He was upset that Karen had not checked herself into an inpatient facility as one would do to conquer substance abuse. He and his parents returned to California and chose to keep their distance after this painful encounter. They made no further attempts to contact Karen's therapist. "What I find interesting," Levenkron stated in 1993, "is that in the entire time Karen was in New York, I got zero calls from the family. I have never treated anyone with anorexia nervosa whose family didn't call regularly because they were concerned." Likewise, Richard claimed to have never received a call from Levenkron.

Karen and Itchie were surprised to learn that Levenkron was not an actual doctor. "We used to call him 'Dr Levenkron' all the time," Itchie explains. "Then we found out that he wasn't even a real doctor. Any medical issues she had, we had to go see this other doctor at Lenox Hill Hospital."

According to Evelyn Wallace, "Karen picked the wrong guy to go to. He wasn't even a doctor. It seemed like Levenkron was simply trying to talk Karen out of having anorexia, but she'd talk to him and she'd go back to the same routine."

By the autumn of 1982 Karen showed no real signs of progress. In fact, her walks to and from sessions with Levenkron kept her body weight beneath the six stone mark. Itchie Ramone called Levenkron and voiced her concerns. "Look, Karen's getting thinner and thinner," she exclaimed. "Plus, it's obvious she doesn't have her usual energy anymore. When do you expect this turnaround? She's just skin and bone."

The therapist agreed that Karen seemed extra tired and was not responding as quickly as he had hoped, and vowed to try another approach. After her next session with Levenkron, Karen asked Itchie if she could borrow a swimsuit. "What?" Itchie asked. "There's no pool in the hotel. Besides, it's cold out!"

"No, I have to wear it tomorrow for Levenkron," Karen answered. The two stopped by the Ramones's apartment to pick up a size 2 light green bikini belonging to Itchie. Karen changed into the bikini and emerged smiling. Itchie was mortified and unable to hide her reaction. "What's the matter?" Karen asked. "It fits."

"Uh, yeah, it fits," she said hesitantly. "You can use it tomorrow, I guess."

Returning to Levenkron the following day, Karen was asked to change into the bikini and stand in front of the office mirror. He urged her to survey and evaluate her body. "She didn't really see any problem with how she looked," Itchie recalls. "In fact, she thought she was gaining a little weight. But she was 79lb."

In mid-September Karen phoned Levenkron and told him her heart was "beating funny". She was quite upset, anxious, and confused. She complained of dizziness to an extent that she was unable to walk. Despite not being medically qualified, he recognised her symptoms as those of someone suffering extreme dehydration. Karen was admitted to New York's Lenox Hill Hospital on 20 September 1982 to begin hyperalimentation, or intravenous feeding.

The next morning she went into surgery to have a small-bore catheter implanted within the superior vena cava (right atrium of the heart). An unexpected complication was discovered later that day when she complained to the nurse of excruciating chest pain, and X-rays revealed the doctors had accidentally punctured one of her lungs in their attempts to insert the tube.

As her lung began to heal, Karen's body quickly responded to the artificial means of feeding. The hyperalimentation process completely replaced all of her nutritional needs, and a precise daily calorie intake was dispensed through the catheter. This loss of control was known to often spark fear in patients, and doctors who oppose hyperalimentation argue that it does not teach the patient to eat properly. However, Karen went along with it and gained 12lb in only a few days. Solid foods were slowly reintroduced as the level of assistance from Karen's IV lessened, and she continued to gain weight steadily. Unlike many other patients she seemed pleased and excited to show visitors her progress. Richard flew in to visit on 25 October and, like most who saw her there, was shocked and saddened. She was still horribly emaciated and barely identifiable by this stage. "You see how much better I look?" she asked.

Richard nodded in agreement but only to appease his sister. In an attempt to divert the attention away from herself, Karen told him of other patients who were much worse off. But he was not sidetracked. "Karen, this is crap," he said suddenly. "Don't you understand? This is crap! You're going about this all the wrong way. This guy isn't getting anything accomplished because you're in a hospital now!"

By November Karen was eating three meals a day at Lenox Hill, and trying to stay positive about the weight gain, by then approaching the 30lb mark. The return of her menstrual cycle, which had ceased during the previous year, seemed to signify an improvement in emotional and physical wellbeing.

On 16 November Karen visited Steven Levenkron for the last time and presented him with a farewell gift, a framed personal message in needlepoint. The large green-threaded words "you win – I gain" served as tangible proof of the long hours Karen had spent alone in the hospital. Learning of her plan to leave, Levenkron reminded Karen she was abandoning the program much too soon, and that treatment takes at least three years. He suggested a therapist in Los Angeles so that she might continue a routine of some sort upon her return home, but she declined. She promised to call him and swore she would not take any more laxatives or diuretics. Agnes and Harold (Karen's father) met up with her at Levenkron's office that day. The couple had flown to New York City to bring their daughter and her 22 pieces of luggage home. It was obvious to most that Karen's treatment was inadequate and ending too soon.

"She tried to get help," says her longtime friend Frenda Franklin. "She went to New York to try. It just wasn't the right way to do it. If this had happened in today's world I think Karen would have lived. I think we would have had a good shot. They know so much more. We were dancing in the dark."

Karen ate heartily on Thanksgiving Day, much to the delight of her family, and she even called Itchie Ramone that night to tell her of all she had eaten. "She said to me, 'I ate this and that and all my favourite things,'" she recalls. "She was very proud of herself then. We were all very proud of her. It seemed like progress."

In the weeks following her return to Los Angeles Karen went back to shopping and socialising without delay. Although others felt she was still quite fragile and thin, Herb Alpert, who had first signed the Carpenters to A&M, saw Karen shortly after the New Year and recalled her looking terrific. She bounced into his office saying, "Hey, look at me, Herbie! What do you think? How do I look?" Alpert agreed that she looked happier and healthier than he had seen her in some time, and felt she appeared to have won the battle. "I am so happy," she told him.

"I'm ready to record again, and Richard and I have been talking about getting the group together and performing."

Despite her high spirits, she was taking more naps than usual and sometimes lying down by seven in the evening. Richard did not believe she was well, and he told her so. On Thursday 27 January Florine Elie drove to Century City for her weekly cleaning of Karen's apartment at Century Towers. There the housekeeper made an unnerving discovery. "When I was working up there I found Karen," Elie says. "She was lying on the floor of her closet." She gently shook Karen who awoke but was groggy. "Karen, is there something wrong?" she asked.

"No, I am just so tired," she replied.

"Maybe you better go lie on your bed," she said, helping Karen up and tucking her into bed.

Florine checked on Karen again before leaving. By then she was awake and adamant she was OK.

Tuesday 1 February found Karen dining with her brother, this time at Scandia on Sunset Boulevard. They were joined by stage producer Joe Layton, and the trio discussed plans for the Carpenters' return to touring. Karen ate with enthusiasm and after dinner returned to Century Towers. This was the last time Richard would see his sister alive.

The next day Karen spoke with Itchie Ramone, who was pregnant with her and Phil's first child. Karen shared her plans for the week. She would sign the final divorce papers on Friday and then prepare to leave for New York. "That weekend, 6 February, she was going to hop on a plane and be there for the birth," Itchie recalls.

Shortly after midnight, staying overnight with her parents, Karen went over her to-do list with Frenda Franklin by phone, and finalised plans for the next day. "OK, I am going to drive in. There shouldn't be a lot of traffic," she said. According to Frenda, Karen enjoyed keeping up with traffic reports. "Then we're going to go get the red fingernail polish." The two had a noon appointment for a manicure in celebration of her divorce.

On Friday morning, 4 February, Karen awoke and went downstairs to the kitchen, where she turned on the coffeepot her mother had prepared the night before. She went back upstairs to get dressed. When the coffee was ready, Agnes dialled the upstairs bedroom phone, but its ring, heard faintly in the distance, went unanswered. Agnes went to the foot of the stairs and called to her daughter but there was no response. Entering the room, Agnes found Karen's motionless, nude body lying face down on the floor of the walk-in wardrobe. Her eyes were open but rolled back. She was lying in a straight line and did not appear to have fallen. "She had just laid down on the floor and that was it," Agnes recalled.

The autopsy report listed the cause of death as "emetine cardiotoxicity due to or as a consequence of anorexia nervosa." The finding of emetine cardiotoxicity (ipecac poisoning) revealed that Karen had poisoned herself with ipecac syrup, a well-known emetic commonly recommended to induce vomiting in cases of overdose or poisoning.

Levenkron claimed to know nothing of Karen's use or abuse of ipecac. In their phone calls she assured him she was maintaining her new 7st 10lb figure and had completely suspended use of all laxatives. He never suspected she was resorting to something much more lethal.

In a radio interview taped shortly after Karen's death, Levenkron discussed the autopsy findings: "According to the LA coroner, she discovered ipecac… and started taking it every day. There are a lot of women out there who are using ipecac for self-induced vomiting. It creates painful cramps, tastes terrible, and it does another thing that the public isn't aware of. It slowly dissolves the heart muscle. If you take it day after day, every dose is taking another little piece of that heart muscle apart. Karen, after fighting bravely for a year in therapy, went home and apparently decided that she wouldn't lose any weight with ipecac, but that she'd make sure she didn't gain any. I'm sure she thought this was a harmless thing she was doing, but in 60 days she had accidentally killed herself. It was a shocker for all of us who treated her."

In one of Levenkron's most recent books, Anatomy of Anorexia, the author boasts of his above-average recovery rate in working with those suffering from eating disorders. "In the last 20 years I have treated nearly 300 anorexics," he wrote. "I am pleased to state that I have had a 90 per cent recovery rate, though tragically, one fatality." That was Karen Carpenter.