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, frequency 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 after 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]. The 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
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