Research Article Factor Structure of CIWA-Ar in Alcohol Withdrawal Ajay Kumar Bakhla, 1 Christoday R. J. Khess, 2 Vijay Verma, 3 Mahesh Hembram, 4 Samir Kumar Praharaj, 5 and Subhas Soren 4 1 Department of Psychiatry, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand 834009, India 2 Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand 834006, India 3 Tulasi Psychiatric and Rehabilitation Centre, Mehrauli, New Delhi 110030, India 4 Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand 834006, India 5 Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka 576104, India Correspondence should be addressed to Ajay Kumar Bakhla; ajaybakhla@gmail.com Received 15 October 2013; Accepted 17 March 2014; Published 6 April 2014 Academic Editor: Otto M. Lesch Copyright © 2014 Ajay Kumar Bakhla et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To identify the underlying factor structure of alcohol withdrawal syndrome, as measured with CIWA-Ar. Methods. Exploratory factor analysis was conducted on the items of CIWA-Ar. On 201 alcohol-dependent male patients seeking treatment for alcohol withdrawal at 36 hours of abstinence. Results. A three-factor solution was obtained that accounted for 68.74% of total variance. First factor had loading from four items (34.34% variance), second factor also had four items (24.25% variance), and the third had two items (10.04% variance). Conclusions. Factor analysis reveals the existence of multidimensionality of alcohol withdrawal as measured with CIWA-Ar and we found three factors that can be named as delirious, autonomic and nonspecific factors. 1. Introduction Alcohol withdrawal syndrome (AWS) is characterized by varied symptoms that range from mild to severe intensity depending on several factors including the quantity, fre- quency and duration of alcohol intake, and the number of prior withdrawal episodes, as well as individual differences in the vulnerability [1–4]. Symptoms usually present themselves within 6 to 24 hours aſter cessation of alcohol intake [5, 6]. Subtyping of the AWS has been attempted in the past, as Gross [7] conceptualized and proposed 3 constellations of alcohol withdrawal symptoms: factor 1 hallucinogenic that consisted of nausea, tinnitus, visual disturbance, pruritus, parasthesia, muscle pain, agitation, sleep disturbance, tactile hallucinations, and hallucinations which are auditory or visual or both; factor 2 affective and physiological that consisted of anxiety, depression, tremor, and sweats; and factor 3 delirium that consisted of clouding of the sensorium, impairment of consciousness, and impairment of contact with the observer. A cluster analytic study [8] identified three different symptoms clusters of alcohol withdrawal, namely, CNS excitation, adrenergic hyperactivity, and delirium. Several rating instruments have been used to measure severity of alcohol withdrawal [9]. Among them, the most commonly used observer-rated scale is the 10-item clinical institute withdrawal assessment-alcohol, revised (CIWA-Ar) [10]. It has been proposed that alcohol withdrawal symptoms in CIWA-Ar appear multidimensional. A PubMed search supplemented with manual search revealed a single factor analytic study of CIWA-Ar [11]. e study by Pittman et al. [11] was to explore the relationship between AWSC and CIWA-Ar, for which they carried out study on 127 male inpatients of alcohol dependence with principle components factor extraction with varimax rotation of CIWA-Ar, a self- rated—alcohol withdrawal symptoms checklist (AWSC) and on combined items of CIWA-Ar and AWSC. ey found three, five, and seven factor solution, respectively, for CIWA- Ar, AWSC, and combination of CIWA-Ar and AWSC. e analysis of CIWA-Ar was done on 7 items as 3 items had zero variance. e first factor (variance 23.9%) was Hindawi Publishing Corporation Journal of Addiction Volume 2014, Article ID 745839, 7 pages http://dx.doi.org/10.1155/2014/745839