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In the additional back story material delivered by creators (Walter Sullivan Victims and Book of the Lost Memories) it was revealed that the physical appearance of Pyramid Head was an effect of James's fascination with Silent Hill folklore. As we may learn throughout the game, Pyramid Head's appearance was a variation of the outfits of the executioners from the Valtiel Sect (connected to the feeling of self-punishment) who were wearing red hoods and ceremonial robes to make themselves similar to the Valtiel, the angel of the town.
Hes basically nothing, but James's imagination.
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