Born to a wealthy Jewish family in Manhattan, New York City, Acker took her last name from her first husband, Robert Acker; though born as Karen, she was known as Kathy by her friends and family. She studied classics as an undergraduate at Brandeis University and aspired to write novels but moved to San Diego to further pursue her studies. Acker's first work appeared in print as part of the burgeoning New York literary underground of the mid-1970s. She claimed that her early writings were profoundly influenced by her experiences working for a few months as a stripper. She remained on the margins of the literary establishment, only being published by small presses until the mid-1980s, thus earning herself the epithet of literary terrorist.[citation needed] 1984 saw her first British publication, a novel called Blood and Guts in High School. From here on Acker produced a considerable body of novels, almost all still in print with Grove Press. She wrote pieces for a number of magazines and anthologies, and also had notable pieces printed in issues of RE/Search, Angel Exhaust and Rapid Eye. Towards the end of her life she had a measure of success in the conventional press—the Guardian newspaper published several of her articles, including an interview with the Spice Girls, which she submitted just a few months before her death.

Janey lived in the locked room.Twice a day the Persian slave trader came in and taught her be a whore.Otherwise ther was nothing.One day she found a pencial stub and scrap of paper in a forgotten corner of the room. She began to write down her life, starting with "Parents stink"(her father,who is also her boyfriend,has fallen in love with another woman and is about to leave her).