The early history of Ava Vitali was shown only in flashbacks as she told the story of her past with Steve to other characters on the show. Ava was the daughter of mob boss, Martino Vitali. She was raised spoiled, sheltered, and in the "family business." Ava met Steve (whom she called "Patch") when Martino hired Patch to do some jobs for the family. (Patch had escaped from the DiMera compound, although all memories of his life with Kayla had been erased.) Ava and Patch fell in love. For two years they dated and were lovers. Eventually, Patch and Ava decided to marry. But, Patch was abducted by the DiMeras and left Ava at the altar. Ava was heartbroken. Later, Ava was diagnosed with brief psychotic disorder after Steve left, and her father put her on medication and did not allow her to leave the family grounds.

Ava appeared on screen in February 2008 in Ireland. Ava was desperate to get Steve back, so she ordered the sabotage of the plane that carried Steve and other members of the Brady family. She was hoping that the plane would be delayed. Instead, the plane had problems mid-flight. The plane crashed and three people, including grandpa Shawn Brady, were killed. Ava followed Steve back to Salem. While mourning Shawn's death, Hope hugged Steve. Ava saw them and mistook Hope for Steve's wife. Ava kidnapped Hope and held her prisoner at the Vitali compound. Steve, Bo, and Kayla followed in pursuit of Hope, and they were held captive, as well. Ava's reign of terror continued as she did many things to physically and emotionally harm her prisoners. Finally, Roman and Abe rescued them and arrested Ava.

While being held prisoner, Kayla had a talk with Ava about her doctor's appointments. Ava told her that the doctor her father hired prescribed pills for her to take. Kayla stole the pills and had them analyzed. The tests showed that the pills prescribed for Kayla were anti-seizure medication, which caused mood swings and manic episodes-a toxic combination for a woman suffering from brief psychotic disorder. Ava went through a painful detox and emerged as a much healthier person.

Ava confronted her father about the pills in the middle of the Brady Pub, surrounded by Bo, Angelo, and other Vitali goons. He denied doing anything wrong and, unfortunately, Ava's doctor had mysteriously died and couldn't comment on the situation. Ava also confronted her father with her mother's death. Ava confessed that she overheard a conversation between Martino and one of his men where Martino confessed that he had Ava's mom killed. When Ava tried to attack Martino, he pulled a gun on her, but Bo shot first. Martino died instantly.

With no more Steve and no more "daddy," Ava tried to move on with her life. She hired E.J. DiMera to be her lawyer when she faced charges for tampering with the plane from Ireland. She also started a friendship with Nicole Walker and the two began patrolling the town for martinis and men. Ava met and took a liking to John Black DiMera, who was separated (though not legally) from Marlena. Ava convinced John to move forward with his new lifestyle as head of the DiMera empire. However, when E.J. told Ava that it did not look good for her to beat the charges since one of her cousins agreed to testify against her, Ava jumped bail and left John and Salem behind. It is believed that she was headed for her family's private compound in Tuscany.

In 2015, Ava befriended Joey Johnson by swearing to him that she wanted to help reunite his parents after all the things she had done to them in the past. Joey and Ava schemed for Steve and Kayla to meet several times. Joey fell in love with Ava in the process.

Ava was using Joey to get revenge on Kayla and steal Steve for herself. Eventually, Ava kidnapped Kayla and held her prisoner. She told Steve the only way he'd learn of Kayla's location was if he went to bed with Ava. Steve did and Ava gave Joey the information on where Kayla was.

But Joey was furious with Ava. While she was in the hospital, a drunken Joey came into her room and smothered her to death with a pillow. He was sure that was the only way to make sure she didn't hurt his family again. Steve took the blame for the crime. He plead self-defense and did not serve jail time.