Hamilton Anxiety Scale

Having 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 (HAM-A) might be useful.

In 1959, psychiatrist Max Hamilton published “The Assessment of Anxiety States by Rating,” a tool for measuring anxiety neurosis (as opposed to anxiety related to a threat). 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.

Items on the HAM-A

The Hamilton Anxiety Scale 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 irritability, fearful anticipation, or a tendency to assume the worst.
2. Tension, both emotional and physical — including being easily fatigued, having an exaggerated startle response, crying easily, trembling, restlessness, or an inability 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, broken sleep, being 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, early waking, hopelessness, mood swings, etc.
7. Somatic anxiety symptoms (muscular), such as muscle pain or tightness, twitching, jerking, stiffness, teeth grinding, increased muscular tone, and a trembling voice.
8. Somatic symptoms (sensory), like hearing issues due to tinnitus, blurred vision, weakness, hot and cold flushes, and a prickling of the skin.
9. Cardiovascular symptoms, which could include a rapid heart rate, fainting sensations, chest pains, and faintness.
10. Respiratory symptoms, like rapid respiration, shortness of breath, pressure in the chest, or a sense of choking.
11. Gastrointestinal symptoms, such as nausea, vomiting, diarrhea, abdominal fullness, wind abdominal pain, constipation, burning sensations, and trouble swallowing.
12. Genitourinary symptoms, which relates to concerns 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 symptoms, such as hair standing on end, a tension headache, dry mouth, being 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

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 for measuring anxiety symptoms

Doctors and researchers have used the Hamilton Anxiety Rating Scale (HAM-A) for decades to assess anxiety severity in individuals, but its accuracy and reliability in the modern day are somewhat debated. One study from 1988, for example, suggests that the HAM-A reliability/validity data is sufficient. However, that same study indicates that the scale may not be sufficient for determining the effects of treatments when medication is involved.

Seeking support for an anxious mood and other anxiety symptoms

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.

Research suggests that it creates “equivalent overall effects” to in-person therapy, so you can be confident in receiving the care you may need regardless of the method you might choose. With an online therapy platform like BetterHelp, you can be matched with a licensed therapist who has experience treating anxiety and depressive disorders. You can meet with them via phone call, video chat, and in-app messaging to address the challenges you may be facing.