The format runs on a simple beat: an alt girl with piercings and dark makeup is shown while a caption jokes that her favorite song is 'Misery' by Pupsies1. Many videos push the phrase 'dad play Misery' or 'dada turn on dat misery,' a running gag that also implies the girls are into ageplay5. Images of X user @himonkeyhamie became a recurring face for the format, though other alt girls also appear4.

The joke heavily overlaps with the Dream Girl Wallahi template, with commenters ironically tagging misery girls as somebody's dream girl3. Defense posts pushed back as the format spread, arguing that not every alt girl is into 'Misery' or the ageplay angle and calling out meme accounts for turning real people into punchlines3.

Creators typically pair a photo or clip of an alt girl with piercings and dark makeup with a caption casting 'Misery' by Pupsies as her favorite song, often using the phrase 'dad play Misery' or 'dada turn on dat misery'5. Many of the biggest edits use images of X user @himonkeyhamie as the face of the joke, though other alt girls work too4.