When a twin dies before birth, the sole survivor needs help and understanding. Womb twin survivors are the sole survivors of a twin or multiple pregnancy. This group, 1 in 10 of the population, includes survivors of a stillbirth, miscarriage, abortion and a "vanishing twin" pregnancy. It is a story of a twin bond broken by death, leaving a lonely survivor.
The original purpose of the questionnaire was to clarify the subjective experience of womb twin survivors. This developed into an attempt to produce a psychological profile. At first, there was no way of knowing whether womb twin survivors felt any differently from the rest of the human race. Until then, the only feelings that had been mentioned in other research with the sole survivors of a twin or multiple pregnancy were “loneliness” and “a sense of something missing.” That does suggest that the missing twin in the Dream may after all be a real memory, but there was much more to discover.
Part of the work of this project has been to try and put the Dream of the Womb into words. To do that has required a great deal of intuitive guess-work and negotiation, with many hundreds of womb twin survivors over many years.
The emails were a written testimony of how people felt about being a womb twin survivor - this was rare and precious material. If anything useful was to be learned from these emails there were just two options: one was to create a list of the most commonly-used statements in the emails and form them into a questionnaire, in order to find the statements most often agreed to and therefore most characteristic of womb twin survivors generally.
The other option was to collect all the emails and analyse each one to discover the most commonly-stated ideas, according to a style of research known as “Critical Interpretive Research.”[i] This kind of research applies particularly in areas where the use of questionnaires with fixed responses may be limiting. This kind of enquiry aims to characterize how people experience the world, so it is necessarily open-ended.
The first step in this style of research is data collection, which is then interpreted to formulate an hypothesis. In 2003 when the womb twin research project began, it was the only possible way forward, for it was immediately clear that, however much good data was collected, the traditional scientific method of testing an hypothesis was not going to work in this case.
Testing by the scientific method would have required a significant number of people to come forward voluntarily, who were definitely not womb twin survivors, to complete the same questionnaire under the same conditions, in order to act as a control group. The main problem is that in an unknown number of cases the loss of a twin before birth is symptom-free. As a result any control group, however recruited, would doubtless include an unknown number of womb twin survivors.
The only reliable place to start was a questionnaire to rate a list of statements commonly made by womb twin survivors. This was going to be the simplest and least expensive option - but not to fix the questions too soon. Over five years, six versions of the questionnaire were created and tested on womb twin survivors.
Two types of womb twin survivor
As the emails arrived and a small group of 15 womb twin survivors began to share their stories, it had become clear that much of what they were talking about related strongly to co-dependency. But this was not the whole story: there were also womb twin survivors with a view of themselves that was almost opposite. For example, one group spent a great deal of time looking after other people, while the other were preoccupied with maintaining their personal welfare. The prevailing feeling for the first group was “abandonment” and “mourning”, but for the second group it was “prevailing anxiety” and “a desire for personal freedom.” The Mourning group was called the “M-type” (for mourning) and the second group was named the “C-type” (for captive).
Questionnaire Type One: making a start
To establish the relative size of these two groups, a list of statements was created. They were presented as an online form as a series of 48 statements in a so-called “diagnostic” questionnaire. For the M-types, some were taken from a list of the characteristic traits common in co-dependency[ii], and there were an equal number of statements that seemed to be characteristic of C-types. For example, there were two opposite statements about change: “I frequently make resolutions to change my life” (M-type) and “I resist change - sometimes for a very long time.” (C-type.)
Each respondent could vote “yes” or “no” to each statement if they agreed or not. Over the space of one month in 2003, just 10 people completed it. The preliminary results revealed that some statements were particularly popular:
·I feel different from other people
·Some degree of personal privacy is very important to me
·It feels like I am searching for something but I don’t know what it is
There was also another quite unexpected result - half of the respondents checked equal numbers of M-type and C-type questions. It was assumed that this meant that a third type of womb twin survivor existed. After some further consultation with each of them, this group was called the D-type (death), because they seemed to be preoccupied with death and dying. It was time to test out this new idea.
Questionnaire Type Two: identifying three “types”
A new form was created with ten sets of three statements, in each set one statement for each “type” of womb twin survivor. They were: deep feelings; being normal; attitudes to intimacy; self-esteem; being heard; ways of grieving; the management of anger; shame and guilt; searching and the balance of power.
For example, the Shame and Guilt set were:
·I experience a prevailing sense of survivor guilt (M-type)
·I often feel that when things go wrong it’s all my fault (C-Type)
·I hate it when other people make me feel ashamed (D-type)
·None of the above seem true for me
12 people completed this second questionnaire over several months. The results clearly showed three types of womb twin survivor, with the D-types dominating. Work began on trying to find a set of statements that would reflect the specific D-type experience, but with no particular success. The set of questions that fitted best with the D-Type already existed elsewhere in fact: it was for the “Indigo” children.
“Indigo” children were also called “Millennium” children in a book that relates the existence of these special children to “vanishing twin” phenomenon.[iii] The so-called “indigo” people certainly do exist as a distinct group and have been studied by experts, because they are hard to educate.[iv] They are in fact of all ages, not just children. There is a questionnaire on a special “Indigo Adults” web site to which the D-type womb twin survivors were referred: they found that most of the statements applied to them.[v] It has been assumed therefore, that there is a strong connection between the D type womb twin survivors and the “Indigo” people.
Finding proof of a lost twin
In the meantime, increasing numbers of womb twin survivors, parents of womb twin survivors and therapists were contacting the womb twin survivors web site and sending in emails. The concept of “proof” became an important consideration, for any one of the respondents could have been fantasizing about their womb twin. The respondents could have been responding to the existing material on the web site, which at that stage consisted of a brief description of how M-type and C-Type womb twin survivors feel about themselves and how they may move towards healing.
However, because of the open and sincere tone of the emails and the increasing consistency in the ideas put forward, it was determined to take every email seriously and respond accordingly. This policy has helped the visitors to the site as much as it has developed the research.
Questionnaire Type 3:gathering stories
The third version of the questionnaire was given a more sophisticated look. Some space was allowed for respondents to add as much additional information as they wanted. 34 people completed this version of the questionnaire in eight months. The stories and additional remarks proved a good resource for extending the number of questions in the next version.
Questionnaire Type 4: adding more statements
Now that the three “types” had been identified, it was time to develop the questionnaire a little more. The first step was to increase the number of statements to include more feelings, behaviors, attitudes and beliefs. Consequently, the fourth questionnaire had 74 statements. It was completed by 100 people in six months. On analysis, the favourite statements were found to be:
·I have a strong inner life, which I use as a coping mechanism
·I need a lot of personal space
·I feel restless and unsettled
·I have been searching for something but I don’t know what it is
·People think of me as an unusual person
Again, as was shown in the first questionnaire, the issues of “personal space”, “searching” and “being different” were obviously very important.
It was noticed that many womb twin survivors did not know what medical signs there were that could prove that their mother was carrying twins at some point in the pregnancy. An extensive literature search was carried out to put together a complete list of the physical signs of a twin or multiple pregnancy which ended in a single birth. 
Advice was sought from a database expert, a psychologist and others about how to formulate a set of questions that would produce more reliable data. It was time also to expand the responses from a simple Yes or No to allow for shades of opinion.
Questionnaire Type 5: pregnancy details included
Type 5 gathered the pregnancy data and in addition there was a list of 70 questions about relationships; a sense of self; behavioural problems and mood and motivation.The questionnaire was left in place on the web site for two years. During that time, 200 responses were gathered.
The results showed that, regardless of whether or not there was medical proof of the lost twin, the top 10 most popular statements were:
1. Deep down, I feel alone, even when I am among friends
2. I know I am not realising my true potential
3. I have been searching for something all my life but I don’t know what it is
4. I fear abandonment or rejection
5. I grieve deeply and for a very long time after someone close to me, or a beloved pet, has died
6. I feel different from other people
7. I have a problem with expressing anger - either there is too much or too little
8. I feel the pain of others as if it were my own
9. There are two very different sides to my character
10.There is at least one room (including shed or garage) in my home that is completely full of stuff.
The “loneliness” and “feeling different” were still there, but some additional, unexpected effects were beginning to emerge, including a tendency towards hoarding, which was of particular interest. These results were presented at the 12th International Congress on Twin Studies in Ghent, Belgium, in 2007.
Questionnaire type 6: the final version
As the questionnaire seemed to be producing helpful results, it was decided to keep it as it was, but refine the questions. Two other frequently-mentioned statements were added, which were, “All my life I have felt something is missing” and “All my life I have carried deeply felt emotional pain that persists, despite all my efforts to heal myself.” This was to be the final version of the questionnaire, to be made available online until 1000 completed questionnaires had been received.
The first 500 of the completed Type 6 questionnaires were sent in 2009 for analysis to the University of Hertfordshire. A preliminary professional analysis of the results was carried out by the Statistics Department. These were the ten favourite statements:
·All my life I have felt something is missing
·I fear rejection
·I know I am not realising my true potential
·I feel different from other people
·I have been searching for something all my life but I don’t know what it is
·I fear abandonment
·Deep down, I feel alone, even when I am among friends
·I have a problem with expressing anger - either there is too much or too little
·I always feel in some way unsatisfied, but I don’t know why
·All my life I have carried deeply felt emotional pain that persists, despite all my efforts to heal myself.
We now have 1000 questionnaires completed.
It is now time to explore in detail the results of this four-year research project and examine each statement in more detail. Many thanks to the 1000 womb twin survivors who have been honest and open enough to reveal their innermost feelings about their lost twin to a compete stranger over the Internet by email. It was a huge act of trust, which I will try not to betray by being very careful about what I say, and maintain anonymity throughout. Without these wonderful people, this research would not have been possible. Without them, the womb twin hypothesis would still be only an intuitive guess and my new book "Womb Twin Survivors - the Lost Twin in the Dream of the Womb" would have no substance.
The questionnaire will stay there, but it may be changed a little to include new discoveries. Its a very good way to make a start on the healing path, so feel free to complete it. I reply personally to every entry.