Hamilton Anxiety Scale (HAM-A)

Evaluates the severity of anxiety and that of other anxious disorders.

Below the calculator you can find more information about the HAM-A questionnaire and its interpretation.

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

The questionnaire can be administered in less than 15 minutes and is addressed to both adults and children. It can also be used to monitor changes in the state of the patient.

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


Anxious mood (worries, irritability)


Tension (restlessness, startle response)


Fears of different kinds


Insomnia (difficulty falling asleep, fatigue)


Intellectual response (concentration problems, poor memory)


Depressed mood (lack of interest, lack of pleasure)


Somatic muscular response (pain, twitching, stiffness)


Somatic sensory response (tinnitus, flashes)


Cardiovascular symptoms (palpitations, chest pain)


Respiratory symptoms (chest pressure, choking, dyspnea)


Gastrointestinal symptoms (abdominal pain, nausea, constipation)


Genitourinary symptoms (micturition frequency, frigidity)


Autonomic symptoms (dry mouth, sweat headache)


Interview behavior (restlessness, increased respiration, hand tremor)

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Scale items

The HAM-A evaluates the presence and degree of severity of a range of anxiety symptoms in order 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:

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, 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 behaviour 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 score Interpretation
0 - 17 Mild anxiety
18 - 24 Mild to moderate anxiety
25 - 30 Moderate to severe anxiety
30 - 56 Very severe anxiety

About anxiety

Anxiety is a condition characterised 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 and after which anxious feelings become a symptom of a mental disorder.

The generalized anxiety disorder (GAD) is the most common diagnosis in people with anxiety, however, there are other conditions that 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.

Specialty: Psychiatry

System: Nervous

Objective: Evaluation

Type: Scale

No. Of Items: 14

Year Of Study: 1959

Abbreviation: HAM-A

Article By: Denise Nedea

Published On: May 27, 2017

Last Checked: May 27, 2017

Next Review: May 27, 2023