Rate the severity of each symptom the patient has experienced over the past week, from 0 (not present) to 4 (very severe).
Not present0
Mild1
Moderate2
Severe3
Very severe4
Score
01Anxious mood: worries, anticipation of the worst, fearful anticipation, irritability.
-
02Tension: feelings of tension, fatigability, startle response, moved to tears easily, trembling, restlessness, inability to relax.
-
03Fears: of dark, of strangers, of being left alone, of animals, of traffic, of crowds.
-
04Insomnia: difficulty falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.
-
05Intellectual (cognitive): difficulty in concentration, poor memory.
-
06Depressed mood: loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.
-
07Somatic (muscular): pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.
-
08Somatic (sensory): tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
-
09Cardiovascular symptoms: tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.
-
10Respiratory symptoms: pressure or constriction in chest, choking feelings, sighing, dyspnoea.
-
11Gastrointestinal symptoms: difficulty in swallowing, wind, abdominal pain, burning sensations, fullness, nausea, vomiting, looseness of bowels, weight loss, constipation.
-
12Genitourinary symptoms: frequency of micturition, urgency of micturition, amenorrhoea, menorrhagia, loss of libido, premature ejaculation, impotence.
-
13Autonomic symptoms: dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.
-
14Behaviour at interview: fidgeting, restlessness, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing.
-
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HAM-A0 / 14
Rate the severity of each symptom the patient has experienced over the past week, from 0 (not present) to 4 (very severe).
Scored locally - nothing leaves this page
01Anxious mood: worries, anticipation of the worst, fearful anticipation, irritability.
02Tension: feelings of tension, fatigability, startle response, moved to tears easily, trembling, restlessness, inability to relax.
03Fears: of dark, of strangers, of being left alone, of animals, of traffic, of crowds.
04Insomnia: difficulty falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.
05Intellectual (cognitive): difficulty in concentration, poor memory.
06Depressed mood: loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.
07Somatic (muscular): pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.
08Somatic (sensory): tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
09Cardiovascular symptoms: tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.
10Respiratory symptoms: pressure or constriction in chest, choking feelings, sighing, dyspnoea.
11Gastrointestinal symptoms: difficulty in swallowing, wind, abdominal pain, burning sensations, fullness, nausea, vomiting, looseness of bowels, weight loss, constipation.
12Genitourinary symptoms: frequency of micturition, urgency of micturition, amenorrhoea, menorrhagia, loss of libido, premature ejaculation, impotence.
13Autonomic symptoms: dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.
14Behaviour at interview: fidgeting, restlessness, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing.
The Hamilton Anxiety Rating Scale (HAM-A) is a 14-item clinician-rated measure of the severity of anxiety symptoms. Each item is rated 0 (not present) to 4 (very severe), giving a total of 0–56. The items span two broad clusters: psychic anxiety (anxious mood, tension, fears, insomnia, concentration difficulties, depressed mood) and somatic anxiety (muscular, sensory, cardiovascular, respiratory, gastrointestinal, genitourinary and autonomic symptoms, plus observed behaviour at interview).
The HAM-A measures severity, not diagnosis. It was written decades before the modern diagnostic categories, so it captures a broad anxiety construct rather than any single DSM or ICD disorder. In contemporary practice it is used mainly to grade symptom severity and track change during treatment - it remains one of the most widely used outcome measures in trials of generalised anxiety disorder.
02 - Origin & purpose
Where it comes from.
Max Hamilton published the scale in 1959 in the British Journal of Medical Psychology as a way of quantifying the severity of "anxiety neurosis" in patients already judged to have anxiety states - he was explicit that it was not intended as a diagnostic instrument. It predates his better-known depression scale's widespread adoption and shares its clinician-rated, interview-based format.
The original publication provided no interview instructions and no anchor definitions for the 0–4 ratings, which left administration to clinical judgement and made scores drift between raters and sites. This gap later motivated structured versions, most notably the SIGH-A (Structured Interview Guide for the HAM-A, Shear et al. 2001), which standardises the questions and anchors. The unstructured original remains the most common form in routine use.
03 - Scoring & cutoffs
How scoring works.
Each of the 14 items is rated 0–4 by the clinician after an interview, giving a total of 0–56. Two severity conventions circulate. The bands shown in the table below are the classical convention used in much of the older literature. A more recent, empirically derived set comes from Matza et al. (2010), who anchored HAM-A scores against clinician CGI-S ratings in a generalised anxiety disorder trial: ≤7 no or minimal anxiety, 8–14 mild, 15–23 moderate, ≥24 severe. In trials, remission is commonly defined as a score of 7 or below and response as at least a 50% reduction from baseline. Whichever convention is used should be reported and kept consistent across a course of treatment.
Score
Severity
Interpretation
0–17
Mild anxiety
Mild anxiety severity.
18–24
Mild to moderate
Mild to moderate anxiety severity.
25–30
Moderate to severe
Moderate to severe anxiety severity.
31–56
Severe anxiety
Severe anxiety severity. Active treatment is usually warranted.
04 - Validation evidence
How well it performs.
The HAM-A shows good internal consistency in clinical anxiety samples, with Cronbach's alpha typically reported between 0.80 and 0.90. Reliability between raters is the scale's known weak point in unstructured use: Maier et al. (1988) reported an inter-rater correlation of 0.74 and questioned how well the scale separates anxiety from depression. When administration is structured, reliability rises sharply - Shear et al. (2001) found inter-rater reliability of 0.99 with the SIGH-A against 0.98 for well-trained raters using the traditional format, though the structured version produced scores about 4 points higher on average, so the two formats should not be mixed within one patient's record. Matza et al. (2010) derived the modern severity bands by mapping HAM-A scores to clinician global severity ratings in 144 GAD patients.
α 0.80–0.90
INTERNAL CONSISTENCY, CLINICAL ANXIETY SAMPLES
r = 0.74
INTER-RATER, UNSTRUCTURED (MAIER 1988)
ICC 0.99
INTER-RATER WITH SIGH-A (SHEAR 2001)
≥24
EMPIRICALLY DERIVED SEVERE BAND (MATZA 2010)
05 - How it compares
How it compares to the alternatives.
Instrument
Items
Time
When to reach for it
HAM-A
14
15–20 min
Clinician-rated severity measure. The standard outcome instrument in generalised anxiety disorder trials and detailed specialist follow-up.
Reach for it as an ultra-brief combined anxiety-depression gate.
06 - When to use it
Right tool, wrong tool.
The HAM-A is a clinician-rated severity measure for patients whose anxiety has already been assessed clinically. It suits grading severity after an interview, tracking treatment response in generalised anxiety disorder, and settings where a clinician-rated outcome is required rather than self-report.
It is not a screening or diagnostic instrument. For screening use the GAD-7 or PHQ-4; for diagnosis, use a structured diagnostic interview against DSM-5 or ICD-11 criteria.
Reach for it when
-Grading anxiety severity after a clinical interview.
-Tracking treatment response in generalised anxiety disorder, including in trials.
-When a clinician-rated measure is required rather than self-report.
-When somatic anxiety symptoms need explicit, itemised attention.
Reach for something else when
-Screening - it needs a trained clinician and 15–20 minutes; use the GAD-7 instead.
-Diagnosing any specific anxiety disorder - it predates modern nosology and does not map to DSM-5 criteria.
-Distinguishing anxiety from depression - six of its items overlap heavily with depressive symptomatology.
-Comparing scores across raters or services that have not standardised administration.
07 - Confidence & precision
Reading the score with care.
No formal minimal clinically important difference has been established for the HAM-A, and a standard error of measurement is not routinely reported because reliability varies so much with administration format. In practice, trials define response as a reduction of at least 50% from baseline and remission as a total score of 7 or below, which coincides with the top of the Matza "no or minimal anxiety" band. Because unstructured inter-rater reliability is moderate (r = 0.74), small score changes between different raters should not be over-interpreted; where possible the same clinician should rate the same patient over time, or a structured guide (SIGH-A) should be used. Note that structured administration runs about 4 points higher than unstructured, so a change of format mid-treatment can masquerade as deterioration.
08 - Limitations
What it cannot tell you.
- The original scale ships with no interview script and no anchor definitions, so unstructured scores drift between raters and services.
- Discriminant validity against depression is weak; Maier et al. (1988) concluded it does not adequately separate the two constructs.
- The heavy somatic loading (7 of 14 items) inflates scores in patients with physical illness and can register antidepressant side effects as "anxiety".
- It predates DSM-III: the construct is a broad 1950s "anxiety neurosis", not generalised anxiety disorder as currently defined.
- Clinician time: 15–20 minutes per administration makes it impractical for routine screening.
- Severity conventions differ between sources; the classical bands and the Matza bands disagree in the mid-range, so the convention in use must be stated.
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