What Is The Hamilton Anxiety Scale, And How Can It Help?

Updated December 22, 2022by BetterHelp Editorial Team

Everyone worries or feels anxious sometimes, but if you have anxiety that interferes with your daily life, it can be a big problem. How do you know when you've crossed the line from everyday worries to clinical anxiety? The Hamilton Anxiety Scale provides a way to identify unhealthy anxiety and gauge its severity.

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What Is The Hamilton Anxiety Scale?

In 1959, Max Hamilton created a tool for measuring anxiety. At that time, there was no generalized anxiety disorder diagnosis, but the scale measures many of its symptoms. Doctors and psychologists use the Hamilton Anxiety Scale or HAM-A to determine the severity of these symptoms.

Items On The HAM-A

The Hamilton Anxiety Scale consists of 14 items that pinpoint the symptoms you might experience if you have anxiety. The following symptoms are recognized and evaluated for severity one the HAM-A:

Anxious Mood

If you have anxiety, it can affect your mood. You may feel irritable, worried, or afraid thinking of the future. It's easy to assume the worst, and you may even plan for it.


This item refers to emotional and physical tension. You may be easily fatigued, have an exaggerated startle response, tear up and cry easily, tremble, feel restless, or be unable to relax.


Fear is natural in certain situations. When it's a realistic fear, it can help you prepare to deal with a threat. However, if you are fearful about things that don't pose a threat or fear things consistently, you may score high on this item. Some common fears are fear of the dark, fear of strangers, fear of being alone, fear of traffic, and fear of crowds.


The HAM-A evaluates insomnia as the inability to sleep and assesses other sleep disturbances, including problems falling asleep, disrupted sleep, feeling tired after sleeping, nightmares, and night terrors.


Hamilton's scale defines its intellectual item as having difficulty concentrating or having a poor memory. This item could also be labeled "cognitive symptoms."

Depressed Mood

Hamilton recognized that people with anxiety also have depression. The depressed mood item encompasses the usual symptoms of depression, including loss of pleasure, loss of interest, and waking early.

Somatic (Muscular)

Somatic symptoms relate to the body. One somatic item on the HAM-A addresses somatic symptoms in the muscles, including pain, twitching, jerking, stiffness, teeth-grinding, trembling voice, and tightness.

Somatic (Sensory)

Somatic sensory symptoms are related to your sense organs. Hearing may be affected by tinnitus, and vision may be blurred. You may alternate between feeling hot and cold, or you may feel weak or have a prickling feeling in your skin.


Anxiety can affect your heart as well. Your heart rate might speed up, you may have chest pains or feel throbbing in your blood vessels, or your heart may skip beats. These cardiac symptoms can also make you feel faint.


The respiratory item measures the severity of symptoms related to your breathing. Anxiety can cause you to hyperventilate, have trouble getting a breath, or feel pressure in your chest. It can cause you to sigh a lot or feel like you're choking.


Gastrointestinal symptoms are common for people with anxiety. These are digestion-related, such as stomachaches, nausea, vomiting, diarrhea, constipation, a feeling of fullness, burning sensations, and trouble swallowing.


Hamilton's scale also measures the effects of anxiety on your genital and urinary health. These symptoms can be related to sexual problems, like premature ejaculation, impotence, and loss of interest in sex. If you're a female, you might also have problems with menstruation.


Autonomic symptoms happen involuntarily, automatically, and unconsciously via the autonomic nervous system. These symptoms include your hair standing on end, dry mouth, flushing, paleness, and sweating.

Behavior In Interview

While the person who conducts the interview will learn much from the information you give them in your answers, they also learn from how you behave during the interview. Hamilton built interview behavior into his scale so that the test-giver could easily include their observations. If they notice you fidgeting, sighing, breathing rapidly, trembling, or doing other observable behaviors, they can include it in the last item on the scale.

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Scoring The Hamilton Anxiety Rating Scale

As the doctor or therapist interviews you, they score each of these 14 items on a scale of zero to four based on whether you present mild, moderate, severe, or very severe feelings for each item. A score of zero means not present, and four means very severe. The next step is to add these numbers for each of the 14 items to get the total score.

The Hamilton Anxiety Scale shows a result indicating the severity of your anxiety. If you score 14 to 17, you have mild anxiety; 18 to 24, moderate anxiety; and 25 to 30, severe anxiety.

How Reliable Is The Hamilton Anxiety Scale?

Doctors and researchers have used the HAM-A for decades to assess a patient’s anxiety severity, yet there is much debate about how reliable the scale is. One study, for example, suggested that the Hamilton Anxiety Rating Scale's reliability and validity are good enough. However, that same study indicated that the scale wasn't sufficient for determining the effects of treatments for anxiety and depression.

Still, the Hamilton rating scale for anxiety has proven helpful for so many years that it will likely continue to be used for the foreseeable future, or at least until more reliable scales are developed.

How Can The HAM-A Help?

It would be natural to assume that a scale that can measure the severity of anxiety could be used for diagnosing anxiety, but that’s not how mental health professionals use the HAM-A. Instead, its primary purpose is to evaluate how much the person is improving during treatment or in research.

The HAM-A is usually given at the start of treatment to establish your condition before you receive help. Then after a course of treatment, the test is given again to determine whether treatment has helped.

In fact, therapists may give it several times during treatment to evaluate the benefits of the treatments used. If the treatments aren't having a positive effect, your doctor or therapist may change tactics or choose a different treatment.

Do I Need The Hamilton Anxiety Scale?

Your doctor or therapist will inform you if they plan to administer the HAM-A. If you feel it would help, you can request it, but you may not need to go through this formal evaluation. A therapist may be able to assess your condition adequately without using this scale.

The important thing is that you get help with your anxiety if it interferes with your life or makes you miserable. Unless the anxiety symptoms are very mild, chances are they won't go away spontaneously. Instead, you must take active steps toward changing your thoughts and behaviors. Getting help as soon as possible is essential because the longer it goes on, the more difficult it can be to overcome your anxiety.

When you're ready to seek help for your anxiety, you have several options. One thing you can do is to talk to a licensed counselor for assistance with anxiety or other mental health concerns by using an online platform like BetterHelp. You simply fill out a short questionnaire to be matched with a therapist who can best guide you.

Online therapy has many benefits, particularly when dealing with anxiety symptoms. It can feel overwhelming to find a local therapist and book an appointment for in-person treatment, especially if you live in an area without many therapists or have to wait for weeks for an open appointment. With online therapy, you have contact to numerous licensed professionals, so you can match with one who is right for you and get an appointment right away.

In addition to being convenient, online therapy is also effective. Studies show that people in online therapy saw “significant and clinically meaningful improvements in depression and anxiety scores” after 12 weeks of treatment that were sustained for six months. If you’re thinking about talking to a therapist to work through your anxiety, connecting with a BetterHelp counselor might be a good option for you.


The Hamilton Anxiety Scale was ahead of its time in that it evaluated anxiety symptoms before generalized anxiety disorder was even an official diagnosis. If you are curious about the HAM-A or want to talk to someone about your anxiety, a BetterHelp therapist can help.

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