Her mother was the daughter of a Baltimore flour merchant, and her father, an Irish-born Presbyterian who came to North America from Donegal before the Revolutionary War,[1] was the second wealthiest man in Maryland after Charles Carroll of Carrollton.

Her other brothers, Joseph and Edward Patterson, were the owners of Joppa Iron Works in Eastern Baltimore County on the Gunpowder River.

On Christmas Eve, 1803, Patterson married Jérôme Bonaparte in a ceremony presided over by John Carroll, the first Catholic bishop of Baltimore.

[3] In the fall of 1804, Jérôme and a pregnant Elizabeth attempted to travel to France in time for his brother's coronation, but a number of false starts delayed them.

Jérôme traveled to Italy in an attempt to reason with his brother, writing to his wife "My dearest Elsa, I will do everything that must be done," but she never saw him again except for a brief eye-to-eye contact in 1822 in a chance encounter at Pitti Palace in Florence (although, like many stories of her life, historians cannot prove this meeting took place).

Despite letters to his wife that he would remain steadfast and not abandon her, Jérôme acquiesed to his brother and was rewarded by being made an admiral in the French navy, a general in the army, an imperial prince and eventually king of Westphalia.

She wrote to Napoleon and convinced him to grant her an allowance, which she used to support herself after her father claimed what little money and goods Jerome had sent her from Europe before their marriage was annulled.

The rifts that had been present between Elizabeth and her family all her life were exacerbated by her marriage and her choices to pursue celebrity in both America and Europe rather than to be an obedient daughter.

Her family strife was compounded by her anger at Bo's choice of American heiress Susan Williams for a wife, a rift that never was resolved.

[6] On February 15, 1861, the Tribunal of the Seine ruled that "demands of Madame Elizabeth Patterson and her son, Jerome Bonaparte, are not admissible, and must be rejected.

The episode "Duty" of the Hornblower television series features Elizabeth (played by Camilla Power) and Jérôme trying to land in France, and the diplomatic difficulties.