Misery incorporates notable autobiographical elements, reflecting King's personal experiences with addiction and the pressures of fame.

King has openly discussed his issues with substance abuse during the period he wrote Misery. From 1976 to 1986, he abused alcohol and cocaine. In a Rolling Stone interview, King states, "Misery is a book about cocaine. Annie Wilkes is cocaine. She was my number-one fan" (Andy Greene, "Stephen King: The Rolling Stone Interview." Rolling Stone, 31 October 2014).

The character of Annie Wilkes can be interpreted as a representation of King's addictions, which controlled and confined him, much like Annie does to Paul. Annie's unpredictable and violent behavior mirrors the chaotic influence that addiction had on King's life, disrupting his creativity and personal well-being.

The novel also delves into the relationship between an author and their audience, a dynamic that King experienced firsthand. The character of Paul Sheldon, who wants to move beyond his popular Misery series to write more serious literature, parallels King's own desires to explore different genres and themes beyond horror. The pressures Paul faces from Annie to continue writing what she loves can be seen as a reflection of King's own challenges with meeting the expectations of his fan base while pursuing his artistic aspirations.