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Hamilton Anxiety Screening

The Hamilton anxiety scale provides an accurate assessment of the severity of the most common anxiety symptoms to help in the evaluation of patients suffering from anxiety and other anxiety disorders.

The questionnaire can be done in less than 15 minutes and is addressed to both adults and children.

Each of the 14 items is scored on a scale from 0 to 4, where 0 means the described symptoms are not present and 4 means that the symptoms are very severe.

The HAM-A score results range between 0 and 56:

HAM-A Score Interpretation

0 – 17 Mild anxiety
18 – 24 Mild to moderate anxiety
25 – 30 Moderate to severe anxiety
30 – 56 Very severe anxiety

Hamilton Anxiety Screening | Scale items

The HAM-A evaluates the presence and degree of severity of a range of anxiety symptoms to provide a patient status that varies from mild to very severe anxiety.

The scale, created by Hamilton in 1959, is addressed to adult and pediatric patients, takes less than 15 minutes and is clinician-rated.

It can be used for an initial assessment or to monitor changes in the anxious symptoms the patient experiences over time.

The three major domains are mental status, cognitive and physical condition. The following table introduces the items in the scale and a description of the symptoms they refer to:

Hamilton Anxiety Screening | HAM-A Items          Symptoms

Anxious mood                              Refers to worries, fearful anticipation, irritability, and pessimism.

Tension                                         Feelings of restlessness, fatigability, startle response, or trembling.

Fears of different kinds                Presence of phobias, such as fear of dark, strangers, small spaces, isolation.

Insomnia                                       Difficulty falling asleep, lack of sleep, nightmares, sleep-walking.

Intellectual response                    Poor concentration, poor memory

Depressed mood                          Complete lack or loss of interest in activities previously enjoyed.

Somatic muscular response         Pains and aches, stiffness, twitching, stiffness, grinding of teeth, and increased muscular tone.

Somatic sensory response.          Weakness, tinnitus, vision flashes and blurring, distorted temperature perception.

Cardiovascular symptoms           Palpitations, tachycardia, chest pain, the throbbing of vessels.

Respiratory symptoms                 Choking sensation, chest pain or pressure, dyspnea, sighing.

Gastrointestinal symptoms         Nausea, abdominal pain, burning sensation, vomiting, constipation, weight loss.

Genitourinary symptoms            Urinary frequency and urgency, frigidity, dysmenorrhea, impotence.

Autonomic symptoms                 Headaches, dry mouth, sweating, pallor.

Interview behavior The patient shows restlessness, increased respiration, or hand tremors.

HAM-A Scores

Each of the items in the anxiety scale is scored based on a Likert scale from 0 to 4:

0 – symptoms not present;

1 – mild prevalence of the symptoms or feelings;

2 – moderate prevalence of the feelings or symptoms;

3 – severe display of feelings and symptoms;

4 – very severe prevalence of the symptoms.

Therefore, the final score ranges from 0 to 56. There are four categories of results:

HAM-A scoreInterpretation0 – 17Mild anxiety18 – 24Mild to moderate anxiety25 – 30Moderate to severe anxiety30 – 56Very severe anxiety

About anxiety

Anxiety is a condition characterized by an inner state of turmoil, irritability, and fear, which triggers a fight or flight somatic reaction of the body.

While most people experience feelings of fear or anxiety at some point in their lives, there is a limit after which these become pathologic. After which, anxious feelings become a symptom of a mental disorder.

Generalized anxiety disorder (GAD) is the most common diagnosis in people with anxiety. However, other conditions display similar symptoms, panic attacks, or specific phobias.

Original Source

Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32:50 – 55.

Other References

1. Clark DB, Donovan JE. Reliability and validity of the Hamilton Anxiety Rating Scale in an adolescent sample. J Am Acad Child Adolesc Psychiatry. 1994; 33(3):354-60.

2. Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity, and sensitivity to change in anxiety and depressive disorders. J Affect Disord 1988;14(1):61–8.


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Please also see
PHQ-9 Depression Screening Tool
GAD-7 Anxiety Screening Tool
TMS Therapy for Adolescent and Teen Depression

Hamilton Anxiety Screening