Speaking with MTV News' Sway Calloway, Usher said the old-school sound of this song reflects Looking For Myself's aim of representing the variety of musical styles that have impacted him. "'Twisted' is more of a nostalgic record, so when you think about the classic R&B record, we managed a way to modernize it, even though that's very relevant," he said. "You hear records like Cee Lo, you hear Bruno Mars and also Andre 3000, and that sound is very relevant in this time. So this was kind of our way to tie it all together and give you something different that you probably wouldn't normally get from me."
The Neptunes produced the song, which also features a vocal from Pharrell Williams of the production duo.
Musically, "Twisted" was inspired by the Twist dance and Fats Domino. Lyrically, it seems someone is twisting up Usher. The Independent On Sunday asked him if he is singing about his ex-wife, Tameka Foster. "Nah, it's not," Usher replied firmly. "And it's funny because I knew that people would potentially assume that. And me and Pharrell talked about it – and he explained it to me as we were writing. 'Nah,' he said, 'that's not what it's about, Ush.' What it's about is a person who is going through something that he can't understand and can't control this woman's emotion. And it's a song that actually celebrates women."
He added: "Then the other side is this guy saying, 'You gotta be twisted if you think I'm gonna accept this.' Then there's the triple-entendre of just a woman twisting her lipstick."