Killed Joshua to protect daughter Alison.
Conned all of Port Charles into believing that Dr. Chris Ramsey was actually a famous European fashion designer.
Elizabeth returned to Port Charles after a long absence and the mysterious death of her husband, Malcolm. She immediately heads to see her daughter, Alison, but the reunion is not a happy one as Ali slaps her mother and blasts her for all the years that she left her young daughter behind with nannies while Elizabeth traveled abroad with her husband Malcolm and lived the high life. There is yet more unhappiness awaiting Elizabeth when she learns at the reading of her husband's will that not only was she cut off without a cent, but that her husband's fortune is to be split between Alison and Malcolm's long-lost, illegitimate child. Elizabeth strikes a deal with Ali to help Alison find her missing sibling--in exchange for her daughter's half of the Barrington money.
Elizabeth, still smarting from the years of cheating she endured while married to Malcolm, only to be cut off, meets a handsome stranger a bar. The two begin to date, and Elizabeth soon finds out that her mystery man is none other than Stephen Clay, the lead singer of a rock band that has captivated Port Charles. Stephen also happens to be a dead-ringer for Caleb Morley, a vampire who tortured many of the town's residents in 2001. Despite the warnings of many in PC, Elizabeth continues to date Stephen.
When Alison and Elizabeth get a lead on Ali's sibling, Stephen lets them use his jet to fly to Canada to meet with the women. On the way there, the plane runs into bad weather and crashes on an island. Alison is badly injured, and Elizabeth realizes just how much she loves her daughter. She makes an emotional plea for her daughter not to die, as they've just found each other again. Elizabeth wants to make up for all the time they've lost, and all the pain she has caused, and is starting right that second. Stephen, in the meantime, tends to Ali's wounds, and saves her life.
Soon after the three are rescued and brought back to Port Charles (where Alison fully recovers), Elizabeth goes to Stephen to tell him that they can no longer see each other. She is re-prioritizing her life, and has decided that she needs to put her daughter first. "I'm sorry, but I can't let you do that, " replies "Stephen," as he bares his fangs, his eyes glow red and he bites her.
At first Elizabeth did not realize she had been turned into a vampire. All she knew was that she was not feeling well, and that Stephen was urging her to drink some special water "to keep her strength up."
Meanwhile, Elizabeth and Alison grew closer. Elizabeth confessed to setting up the meeting with the woman in Toronto as a way to get her daughter's money--she gave her apologies, and to show she was sincere, she not only tore up the agreement that gave her Alison's millions, but also promised to help Ali find her half-sibling. She also began helping Ali plan her upcoming wedding to Rafe.
Elizabeth begins to become concerned about the way she has been feeling--tired, worn-out and endlessly hungry, though she doesn't know what she's hungry for. She becomes even more worried when she feels an inappropriate urge to bite Ian's baby, Danny. When she tells Stephen, he tells her to stop fighting her urges, and she gives in, feeding on Stephen. But, instead of feeling happy about her gift of eternal life, Elizabeth is soon horrified when she realizes what she has become.
When Rafe and Alison walk down the aisle to be married, Alison suddenly believes that Rafe might be her missing sibling and bolts from the church. Rafe follows her and the wedding is cancelled. However, "Stephen" prevails upon Elizabeth to marry him, since all the guests are assembled in the church. Although Lucy protests their decision, Stephen and Elizabeth are married. But, after they are married, "Stephen" leaves Elizabeth alone in their hotel room while Stephen, who really is Caleb, is haunted by memories of Caleb's one true love ~ Olivia. Alone in her hotel room after Alison's canceled wedding, Elizabeth can no longer fight her urges and performs the big non-no in Stephen's book: Elizabeth bites Ian and transforms Ian into a vampire.
After Elizabeth learns that Alison believes that Alison's sweetheart, Rafe, might be Malcolm Barrington's missing offspring and, therefore, Alison's sibling, Elizabeth, keeps her promise to help Alison find information about her brother or sister, Elizabeth accompanies her daughter to Capri (where Malcolm's yacht is docked). Stephen again lends the two women his plane, but sends his henchman Joshua to spy on them in Caleb's place when Caleb decides to stay in Port Charles at the last minute. Both on the plane and at the hotel in Capri, Joshua makes unwanted advances towards Alison. At the hotel, Joshua and Elizabeth argue and Joshua drugs Elizabeth's drink. Elizabeth passes out, and, when Ali comes in to check on her mother, Joshua again makes a frightening advance towards Alison. Just as Joshua is towering menacingly over Ali, Elizabeth comes to, grabs Joshua and sinks her teeth into him! Elizabeth soon freaks out, both because she killed a man and because she hadn't wanted Alison to see her "like that." Ali assures Elizabeth that she has known for a while that her mother is a vampire (slayer Rafe had figured it out and warned Alison). Alison admits to her mother that Rafe had stowed away aboard their plane and is in Capri with them. After Alison summons Rafe, the slayer assures the two women that he will take care of disposing of Joshua's body in such a way that Elizabeth would never been questioned about Joshua's 'disappearance.' Alison and Elizabeth gratefully agree to let Rafe take care of the details. Later, Rafe finds conclusive proof that Alison's missing sibling was definitely a girl. Privately, however, Rafe reminds Alison that, since her mother has "crossed over" by killing someone, Elizabeth's soul will be lost forever.
Later, the two women high-tail it back to PC, where Elizabeth is haunted by visions of Joshua. One day, one of these "visions" reaches out to grab her--Joshua in now a vampire, just like herself. Joshua thanks Elizabeth for giving him what Caleb never would ~ The Gift of Eternal Life. Joshua proposes that they join forces to take Stephen/Caleb down. Elizabeth, angry at the husband she has recently left because of his obsession with Tess, agrees and Joshua feeds on her. Disgusted, Elizabeth pulls back, but soon heads over to Ian's, hoping to find some comfort there. However, Elizabeth finds that Ian is gone. Instead, Elizabeth finds Ian's notes which state that IF a vampire sleeps with a slayer, the action will reduce the vampire's urge to feed. She gets the idea to seduce Rafe, her daughter's fiancé, but Rafe manages to fend her off. When Rafe learns that Joshua is "alive" and menacing Port Charles, Rafe assures Alison that, since her mother did NOT kill anyone, Elizabeth's soul is not irretrievably lost yet. However, Rafe also warns Alison and their close friends that Joshua's grab for power might prove to be more dangerous than the menace posed by Caleb.
In the meantime, slayers Rafe and Lucy have come up with an idea to rid Port Charles of the vampires. They had discovered, through clues in the first five notes of Stephen's song "Naked Eyes," that there is a healing spring that runs beneath Port Charles (it is this water that Caleb used in his "special water" that helped curb vampire urges to feed). They soon realize that the pool will make a vampire, who has fed, mortal again. An eavesdropping Elizabeth overhears, and, desperate to be "normal" again, Elizabeth dives into the pool. Elizabeth emerges cured of the curse of Caleb's version of 'eternal life.'
Unfortunately, the plan to de-vamp PC doesn't go quite as well as anticipated. While most of the vampires are "cured" (including Caleb), Joshua and the newly-fanged Livvie are not. What's worse is that Joshua has stepped up his plans to become the Vampire King in Caleb's place. Joshua has begun to turn various other PC residents into vampires and plans to marry Alison and turn her into his Vampire Queen.
Elizabeth goes to visit Caleb in the hospital to gloat, but is soon sweet-talked into helping her estranged husband escape from the hospital, at which point Caleb promptly leaves a devastated Elizabeth behind.
When Joshua has henchman Frank kidnap Alison for him, Elizabeth heads out with Lucy to save her daughter. They go to Joshua's hideaway, where Elizabeth finds the wedding rings meant for her daughter. Just then, Joshua enters and Lucy hides, but Elizabeth is not quick enough. Instead, Elizabeth convinces Joshua that she thinks that the rings are meant for the two of them, that she accepts Joshua's "proposal," and that she will let him turn her back into a vampire. Just as Joshua is about to bite Elizabeth, Lucy jumps out of the closet with a hanger fashioned as a stake, and Ian and Frank enter. Joshua orders Frank to kill Elizabeth, but Ian opens a secret door and she escapes.
Some time later, Joshua summons Elizabeth to his lair in the middle of the night. He wants her to convince Alison that a life as his wife is what's best for her. Elizabeth refuses, and leaves with Kevin (who had been sketching Elizabeth). The two get a drink and flirt, and she goes back with Kevin to the Lighthouse so he can continue sketching her. Elizabeth is there when Joshua shows up with "proof" provided by Livvie that Alison is dead--and Livvie has killed her! Elizabeth runs off in despair, devastated by her daughter's death. But unknown to her, it is a plan put into motion by Alison, Rafe, Caleb and Livvie to capture Joshua. Alison is alive and well, hiding while her mother grieves.
Rafe, Alison, Livvie and Caleb team up and succeed in defeating Joshua, who suddenly disappears. Rafe and Caleb argue about the missing Morley Family Heirloom Power Ring, which grants every wish to whomever possesses the ring, and was in Joshua's possession when Joshua disappeared. Elizabeth remains oblivious to the search for the Power Ring and continues to make efforts to make her daughter proud of her. When Rafe and Alison decide to open their own gym, Elizabeth brags that she is close friends with a famous European fashion designer, named Georges, who has promised to come to Port Charles and design a special line of sports clothes for Alison's gym. Alison is thrilled and immediately begins making plans for a special fashion show at the gym. However, as the plans for the fashion show progress, Elizabeth confides to Dr. Chris Ramsey that her friend Georges has stood her up and is not coming to Port Charles after all. Elizabeth is surprised when Chris suddenly shows up, impersonating Georges, and assures Alison that he will definitely be designing a special line of clothes just for the opening of Alison's gym. However, after Chris makes George's grandiose promises, Elizabeth reminds Chris that neither one of them has ever actually designed any clothes! Chris and Elizabeth go back to Elizabeth's hotel room to brainstorm and, while the two flirt with each other, Elizabeth suddenly discovers that she actually DOES have a talent for designing clothes. After Alison discovers Chris and Elizabeth alone together in Elizabeth's hotel room, Elizabeth and Chris decide that the only way to keep their impersonation under wraps is by pretending to the world that they have become a "couple." Although Chris and Elizabeth get into an argument just before the fashion show and Chris storms away, Elizabeth is impressed when Chris suddenly returns in time for the fashion show and, once again, impersonates Georges in order to help Elizabeth maintain her charade. After the fashion show, at which Kevin is injured while Livvie is making another attempt to get rid of Alison, Elizabeth is surprised when she realizes that her fashion designs were a hit. Elizabeth surprises Chris by moving into his apartment with a crew of tailors to produce Elizabeth's Fashions in order to meet all of the orders. Although Chris keeps protesting that he DOES have other duties at the hospital, Elizabeth succeeds in persuading Chris to continue to impersonate Georges for public appearances, and Chris eventually goes along with Elizabeth's scheme. In the meantime, Chris also works with Ian to try to find a cure for Ian's vampirism, since Ian had not bitten anyone and was NOT cured by the healing spring under Port Charles. In the meantime, Caleb and Livvie regain control of the Morley Family Heirloom Ring. Unbeknownst to Elizabeth, Rafe and Alison decide to suddenly elope and be married at a Luxury Resort outside of town. Rafe surprises Alison by making it possible for Alison's friends and family to join them for the wedding. As Rafe and Alison are finally married at the resort, their happy friends remain unaware that Alison spent a night of passion with Caleb. And, after Caleb and Livvie are married in a different ceremony at the SAME resort, Caleb informs Livvie that there is a good possibility that Alison may soon become the mother of Caleb's child!