Elisabeth Karamichailova was born in 1897 in Vienna, to Ivan Mikhaylov and Mary Slade. Both her parents had studied at the University of Vienna - Ivan, born in Shumen, was studying medicine, while Mary, a native of Minster Lovell in Oxfordshire, studied music. After her father graduated in 1907, the family remained in Vienna for two years before moving to Bulgaria in 1909 where they acquired a spacious house in central Sofia.
Karamichailova grew up in both an artistic and scientific environment. Her father turned the upper floor of his house into a Red Cross Hospital where he treated his patients without requiring payment. She enrolled in the Sofia Girls' College and graduated there in 1917, after which she departed to study at the University of Vienna.