Hamilton Anxiety Rating Scale

Feeling a sense of worry or anxiety from time to time is a normal part of the human experience for most of us, especially in response to stress or uncertain circumstances. However, if you find yourself experiencing anxiety that’s persistent and negatively impacts your daily functioning, you might have an anxiety disorder and may benefit from seeking support. If you’re unsure as to whether it might be time to seek help for your anxiety symptoms, tools like the Hamilton Anxiety Rating Scale might be useful.

In 1959, psychiatrist Max Hamilton created a tool for measuring anxiety. Generalized anxiety disorder (GAD) was not yet an official diagnosis at that time, but the tool measured many of its symptoms as they are now recognized. As the first tool of its kind, the Hamilton Scale For Anxiety, HAM-A, is recognized for the impact it has had on the field of psychology diagnostics. That said, it has undergone some changes over the years as a result of new research and understanding of anxiety disorders. 

Today, it may be used by some doctors and mental health professionals during the evaluation process to help them determine whether an individual’s symptoms may point toward an anxiety diagnosis.

The HAM-A consists of 14 items that pinpoint the symptoms that an individual with an anxiety disorder might experience. They are as follows:

1. Anxious mood, including feeling irritable, worried, or afraid when thinking of the future along with a tendency to assume and/or plan for the worst outcomes
2. Tension, both emotional and physical—including feeling easily fatigued, having an exaggerated startle response, crying easily, trembling, feeling restless, or being unable to relax
3. Fears, specifically exaggerated or irrational fears that are out of proportion to the situation and cause significant distress
4. Insomnia and other sleep disturbances, including problems falling asleep, disrupted sleep, feeling tired after sleeping, nightmares, and night terrors
5. Intellectual, such as difficulty concentrating, poor memory, and other cognitive symptoms
6. Depressed mood and other signs of depression, which often co-occurs with anxiety, such as a loss of pleasure in activities once enjoyed, hopelessness, mood swings, etc.
7. Somatic (muscular), such as muscle pain or tightness, twitching, jerking, stiffness, teeth grinding, and a trembling voice
8. Somatic (sensory), like hearing issues due to tinnitus, blurred vision, alternating between feeling hot and cold, a feeling of weakness, and a prickling feeling of the skin
9. Cardiovascular, which could include a rapid heart rate, chest pains, and feelings of faintness
10. Respiratory, like hyperventilation, shortness of breath, pressure in the chest, or a sensation of choking
11. Gastrointestinal or digestion-related problems like nausea, vomiting, diarrhea, constipation, and trouble swallowing
12. Genitourinary, which relates to issues with menstruation as well as possible sexual problems, such as premature ejaculation, impotence, and a loss of interest in sex if it was present previously
13. Autonomic, involuntary symptoms like hair standing on end, dry mouth, feeling flushed, and sweating
14. Behavior in interview, which refers to the observations the clinician may make about the individual’s demeanor during the evaluation—such as whether they’re fidgeting, breathing rapidly, or trembling

How results are scored and used

The professional administering the test will score each of these 14 items on a scale of zero to four based on whether the individual presents or reports mild, moderate, severe, or very severe experiences of each symptom. They will then add up the numbers to arrive at a final score, which corresponds to various levels of anxiety severity. A score of 14–17 indicates mild anxiety, 18–24 indicates moderate, and 25–30 indicates severe. 

Though it might seem that the HAM-A would be used by healthcare professionals as a diagnostic tool, its primary purpose is actually to evaluate how much the person is improving during treatment or in research. It’s usually administered at the start of treatment to establish an individual’s condition, and again afterward to determine whether the treatment has helped.

Effectiveness

Doctors and researchers have used the HAM-A for decades to assess anxiety severity in individuals, but its accuracy and reliability in the modern day are somewhat debated. One study, for example, suggests that the Hamilton Anxiety Rating Scale's reliability and validity are sufficient. However, that same study indicates that the scale may not be sufficient for determining the effects of treatments when medication is involved. Still, many healthcare professionals may still use the scale as one guide or information source among others when determining whether a particular course of treatment seems to be positively affecting an individual. On your own, you might use the HAM-A as one way to familiarize yourself with some of the common symptoms of anxiety so you can feel confident in seeking the support you may need.

If you’ve been experiencing several of the symptoms that the HAM-A test outlines, it may be time to seek the support of a mental health professional—especially if the symptoms are causing you distress impacting your daily functioning, or co-occurring with another condition such as a depressive disorder. A therapist can conduct an evaluation to determine whether you may be experiencing a clinical anxiety disorder. If so, they can recommend treatment options—which typically include some type of therapy, sometimes in combination with medication and/or lifestyle changes. 

Some people find it intimidating or anxiety-producing to meet with a therapist in person, especially if they’re already experiencing symptoms of an anxiety disorder. In cases like these, online therapy can represent a more comfortable alternative. Research suggests that it creates “equivalent overall effects” to in-person therapy, so you can feel confident in receiving the care you may need regardless of the method you might choose. With an online therapy platform like BetterHelp, you can get matched with a licensed therapist whom you can meet with via phone, video call, and/or in-app messaging to address the challenges you may be facing.