Recent research has provided strong support for the existence of a familial risk for suicide, and efforts have been made to separate genetic from enviromental risk factors. Twin studies have played a major role in the identification of genetic factors, and the results indicate that the concordance rate for suicide is higher in identical than in fraternal twins (Baldessarini & Hennen, 2004). Moreover, Segal and Roy (1995) reported a significantly higher frequency of nonfatal suicidal attempts by monozygotic (MZ) than by dyzygotic (DZ) twins whose co-twins had committed suicide. However, doubts remain as to whether the increased risk of suicide in MZ twins is a response to the intense grief over the loss of a close relative, or whether a common genotype is associated with suicidal behavior. Sudden loss, which may carry a stigma in the case of a suicide, has been linked to increased persistent emotional stress and physiological changes (Epstein, 1993; Martin & Dean, 1993). A number of researchers have reported greater suicidal ideation among bereaved MZ twins as compared to DZ twins, suggesting that a loss due to suicide may increase the risk of suicidal behavior in the surviving co-twin (Segal & Bouchard, 1993; Segal & Roy, 1995; Segal et al., 1995). The aim of the present article is to address the issue of the intense grief experienced by twins after the co-twin suicide.