Toolkit / Anxiety

HAM-A: Hamilton Anxiety Rating Scale

Clinician, 14 items, scored 0–56, about 15 minutes

Fourteen-item clinician-rated scale covering psychic and somatic anxiety. Each item is scored 0 (not present) to 4 (very severe). Widely used as an outcome measure in anxiety trials.

Patient details for the printout optional · never saved or sent

Left blank, these print as lines to fill in by pen.

Rate the severity of each symptom group on the basis of the clinical interview.

  1. 1Anxious moodWorries, anticipation of the worst, fearful anticipation, irritability
  2. 2TensionFeelings of tension, fatigability, startle response, moved to tears easily, trembling, restlessness, inability to relax
  3. 3FearsOf the dark, of strangers, of being left alone, of animals, of traffic, of crowds
  4. 4InsomniaDifficulty falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors
  5. 5Intellectual (cognitive)Difficulty in concentration, poor memory
  6. 6Depressed moodLoss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing
  7. 7Somatic (muscular)Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone
  8. 8Somatic (sensory)Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensations
  9. 9Cardiovascular symptomsTachycardia, palpitations, chest pain, throbbing of vessels, fainting feelings, missing beat
  10. 10Respiratory symptomsPressure or constriction in chest, choking feelings, sighing, dyspnoea
  11. 11Gastrointestinal symptomsDifficulty swallowing, wind, abdominal pain, burning, fullness, nausea, vomiting, borborygmi, loose bowels, weight loss, constipation
  12. 12Genitourinary symptomsFrequency or urgency of micturition, amenorrhoea, menorrhagia, loss of libido, premature ejaculation, erectile dysfunction
  13. 13Autonomic symptomsDry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair
  14. 14Behaviour at interviewFidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing

Interpreting the total

0–7No or minimal anxiety
8–14Mild
15–23Moderate
24–56Severe

Notes

  • Severity bands follow Matza et al. (2010). A commonly quoted older convention is 17 or less mild, 18–24 mild to moderate, and 25–30 moderate to severe.
  • Psychic anxiety = items 1–6 and 14; somatic anxiety = items 7–13.

References

  1. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50–55.
  2. Matza LS, Morlock R, Sexton C, Malley K, Feltner D. Identifying HAM-A cutoffs for mild, moderate, and severe generalized anxiety disorder. Int J Methods Psychiatr Res. 2010;19(4):223–232.

In the public domain.

An educational aid for clinicians, not a substitute for clinical judgement. Scores support, but never replace, a full assessment. Your answers on this page are never stored or sent.

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