Hamilton Anxiety Rating Scale (HAM-A)

The Hamilton Anxiety Rating Scale (HAM-A) is a widely used clinical tool designed to quantify the severity of anxiety symptoms. Developed by Dr. Max Hamilton in 1959, it is one of the earliest scales of its kind, intended for use with adults particularly in a clinical setting. The HAM-A consists of 14 items, each aimed at assessing a different aspect of anxiety as experienced by the individual. These items are rated on a scale, with the total score providing an overall measure of the person's anxiety level. This test has been important in both the diagnosis and the monitoring of anxiety disorders, facilitating a structured approach to understanding the nuances of an individual’s mental health condition.

The scale's design reflects a comprehensive approach to assessing anxiety, covering both psychological and somatic symptoms. This includes aspects such as mood, fears, tension, insomnia, intellectual (cognitive) symptoms, and somatic complaints, among others. The scoring system ranges from “not present” to “severe”, allowing clinicians to gauge the intensity of each symptom. The HAM-A’s broad coverage of symptoms makes it a useful instrument, suitable for tracking changes over time and evaluating the effectiveness of treatment interventions. Despite its age, the HAM-A continues to be validated against more contemporary measures of anxiety, affirming its relevance and utility in today's clinical environments.

The Hamilton Anxiety Rating Scale remains a foundational tool in the field of psychiatry and psychology, widely used for its intended purpose of assessing anxiety levels in adult individuals. Its enduring presence in clinical settings underscores the ongoing importance of standardized measures in the diagnosis and treatment of mental health disorders.

Below is a list of phrases that describe certain feeling that people have. Find the answer which best describes the extent to which you experience these conditions. Select one of the five responses for each of the fourteen questions.

  Not Present Mild Moderate Severe Very Severe
1. Anxious Mood
Worries, anticipation of the worst, fearful anticipation, irritability.
2. Tension
Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.
3. Fears
Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.
4. Insomnia
Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.
5. Intellectual
Difficulty in concentration, poor memory.
6. Depressed Mood
Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.
7. Somatic (muscular)
Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.
8. Somatic (sensory)
Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
9. Cardiovascular Symptoms
Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.
10. Respiratory Symptoms
Pressure or constriction in chest, choking feelings, sighing, dyspnea.
11. Gastrointestinal Symptoms
Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.
12. Genitourinary Symptoms
Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of rigidity, premature ejaculation, loss of libido, impotence.
13. Autonomic Symptoms
Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.
14. Behavior at Interview
Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc.
  1. M Hamilton. The Assessment of Anxiety States by Rating. 32 Br J Med Psychol 50-55. .
  2. W Maier, R Buller, M Philipp, & I Heuser. The Hamilton Anxiety Scale: Reliability, Validity and Sensitivity to Change in Anxiety and Depressive Disorders. 14(1) J Affect Disord 61-68. .