The creature appears to be a large set of sleeping Siamese twin infants wearing a tattered, dirty smock and what looks like a scarf; they also appear to be feathery to a mild degree. Along with pale skin, they have enormous adult-like arms on which they stand. Their arms come out from underneath their smock, as if their arms are a pair of legs.
The twins will point at Henry Townshend and whisper "receiver", however they will not attack him unless he wanders too close to them or provokes them (i.e. shooting at or attacking), in which case they will lash out and strike at him with their long arms, but otherwise they are relatively ignorant towards Henry even if clearly looking at him. After being disturbed, they will dart about the room fairly quickly, continuously harassing Henry and then running away until killed. They are capable of dealing heavy damage by hitting Henry or jumping on him. When they fall by being attacked, they start "sobbing" and writhing on the floor like young children during a tantrum.
Walter Sullivan's seventh and eight victims were twins Billy and Miriam Locane, who were first mentioned in Silent Hill 2. They are the only two of Walter's victims that have been reincarnated into the form of a monster instead of ghosts.
Although this makes sense for the creature's origin, it is unknown why there are so many of them in the game. However, this can possibly be explained by a potential latter meaning. The Twin Victims are essentially conjoined twins, which occurs when a fertilized cell fails to split properly, making it so two beings are fused together. A main theme in the game is Walter's demented level of attachment and misunderstanding of his mother, and it is revealed throughout the gameplay of just how "glued" he his to her. The Twin Victims could also be a manifestation of this severe attachment.
- In one trailer, the Twin Victims sounded much more like children, with a more distinct high-pitched cry. This was changed for the game and replaced with deep, low grunts. This choice may have been due to censorship issues, as European laws forbid the killing of children in a game, which is why the Grey Child was replaced with the Mumbler in the original Silent Hill game. Despite this, their original screams can still be heard in the game's intro.