Hamilton Anxiety Rating Scale (HAM-A)

Clinician-Rated Assessment

Hamilton Anxiety

Rating Scale (HAM-A)

The Hamilton Anxiety Rating Scale (HAM-A) is a clinician-rated instrument designed to assess the severity of anxiety symptoms. It evaluates both psychological anxiety and physical symptoms associated with anxiety.

Rating Clinician-rated

Administration 10–15 min

Items 14

Total Score 0–56

Clinician Rating

Below is a list of phrases that describe certain feelings and symptoms that people may experience. Rate the patient by selecting the response that best describes the extent to which each condition is present. Select one of the five responses for each of the fourteen questions.

0 = Not present 1 = Mild 2 = Moderate 3 = Severe 4 = Very severe

1 Anxious mood

Worries, anticipation of the worst, fearful anticipation, irritability.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

2 Tension

Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

3 Fears

Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

4 Insomnia

Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

5 Intellectual

Difficulty in concentration, poor memory.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

6 Depressed mood

Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

7 Somatic (muscular)

Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

8 Somatic (sensory)

Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

9 Cardiovascular symptoms

Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

10 Respiratory symptoms

Pressure or constriction in chest, choking feelings, sighing, dyspnea.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

11 Gastrointestinal symptoms

Difficulty in swallowing, wind, abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

12 Genitourinary symptoms

Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

13 Autonomic symptoms

Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

14 Behavior at interview

Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc.

Not present 0 Mild 1 Moderate 2 Severe 3 Very severe 4

Please complete all 14 ratings before calculating the total score.

Total HAM-A Score

0

Not yet rated

Possible score: 0–56

Complete all 14 items to calculate the patient's score.

About the HAM-A

The Hamilton Anxiety Rating Scale was one of the first rating scales developed to measure the severity of anxiety symptoms and remains widely used in clinical and research settings.

The scale consists of 14 items and measures both psychic anxiety, including mental agitation and psychological distress, and somatic anxiety, including physical complaints associated with anxiety.

The HAM-A is clinician-rated and does not provide standardized probe questions. Reported interrater reliability has nevertheless generally been considered acceptable.

Score Interpretation

Each item is scored from 0 (not present) to 4 (very severe), producing a total score ranging from 0 to 56.

Total Score	Interpretation
< 17	Mild severity
18–24	Mild to moderate severity
25–30	Moderate to severe severity
> 30	Very severe range

Clinical note: The HAM-A is a clinician-rated assessment tool and should be administered and interpreted by an appropriately qualified healthcare professional. A score should not be used by itself to establish a diagnosis.

Purpose and Population

The primary purpose of the HAM-A is to assess the severity of symptoms of anxiety. It has been used with adults, adolescents, and children in clinical and research contexts.

Additional Information

The HAM-A has been translated into multiple languages and has been used internationally. The scale is in the public domain.

Reference: Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. Journal of Affective Disorders. 1988;14(1):61–68.

Borkovec T, Costello E. Efficacy of applied relaxation and cognitive behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology. 1993;61(4):611–619.

The HAM-A is in the public domain.