Calculators / Anxiety and trauma

HAM-A

Hamilton Anxiety Rating Scale. Clinician-rated anxiety severity.

Members Library

The HAM-A calculator is in the Library.

Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.

Use it for

  • Rating the severity of anxiety in a person who already has an anxiety disorder.
  • Tracking response and remission through treatment.
  • Trials and clinical work where a clinician rating is wanted.

Do not use it for

  • Screening or diagnosing an anxiety disorder. The GAD-7 is the screen.
  • Separating anxiety from depression with confidence, which it was meant to do, as the item content overlaps.
  • A single quick rating. Done properly the interview takes time, and a structured guide (SIGH-A) improves reliability.

Rate each of the 14 items from the interview and from observation. Use the highest rating that fits for the current state, and consider only what is attributable to anxiety.

Ratings are 0 not present, 1 mild, 2 moderate, 3 severe, 4 very severe. The symptoms listed under each item are examples, not a checklist.

Psychic anxiety

1Anxious moodWorries, anticipation of the worst, fearful anticipation, irritability.
2TensionFeelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.
3FearsOf the dark, of strangers, of being left alone, of animals, of traffic, of crowds.
4InsomniaDifficulty falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.
5IntellectualDifficulty in concentration, poor memory.
6Depressed moodLoss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.

Somatic anxiety

7Somatic (muscular)Pains and aches, twitchings, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.
8Somatic (sensory)Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
9Cardiovascular symptomsTachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.
10Respiratory symptomsPressure or constriction in chest, choking feelings, sighing, dyspnea.
11Gastrointestinal symptomsDifficulty in swallowing, wind, abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.
12Genitourinary symptomsFrequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.
13Autonomic symptomsDry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.

Behavior at the interview

14Behavior at interviewFidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, belching, brisk tendon jerks, dilated pupils, exophthalmos.

HAM-A

Answer the questions to see the result.

This calculator adds up the score in your browser. Nothing you enter is stored or sent.

More about the HAM-A

About the HAM-AWhat it is and what it is for

Max Hamilton published the anxiety scale in 1959 to rate the severity of anxiety in people who already had an anxiety diagnosis, and to tell it from depression. A clinician rates 14 items from 0 (not present) to 4 (very severe), using an interview and observation. The total runs from 0 to 56.

Seven items cover psychic anxiety and seven cover somatic anxiety. The scale is a standard outcome measure in anxiety trials. It leans toward somatic symptoms, which means it can be raised by medication side effects.

How to use itGiving it and scoring it

Interview the person and observe them. Rate each of the 14 items from 0 to 4 for the current state. Add the 14 items for a total from 0 to 56.

Use the same rater and the same interview guide at each assessment.

Interpreting the scoreScore ranges and what they suggest
ScoreWhat it suggestsUsual response
0 to 7No or minimal anxietyThe usual remission range in trials.No treatment from the score alone. If in treatment, continue it and plan maintenance.
8 to 14Mild anxietySome anxiety with limited impairment.Monitor, offer education and first-line psychotherapy or self-help, and treat if it bothers the person.
15 to 23Moderate anxietyClear anxiety with impairment.Active treatment: CBT, medication, or both.
24 to 56Severe anxietyMarked anxiety and impairment.Active treatment, a risk review, and a check for depression and substance use.

Bands are from Matza and colleagues (2010), derived in patients with generalized anxiety disorder, and the authors advise using them with caution. An older convention, with no published derivation, calls 17 or less mild, 18 to 24 mild to moderate, 25 to 30 moderate to severe and above 30 severe. Hamilton published no cutoffs.

Pearls and pitfallsTips and common mistakes
  • Note the baseline total and the date at the start of treatment. Response and remission depend on it.
  • Item 14, behavior at interview, depends on what you see. Rate it at the end of the interview.
  • If the score rises after a medication change, look at which items rose. Side effects can mimic anxiety.
  • For a quick self-report measure of the same domain, use the GAD-7.
EvidenceAccuracy and reliability
  • Hamilton (1959) designed the scale to rate the severity of anxiety in people who already had a diagnosis of anxiety neurosis.
  • Matza and colleagues (2010) derived severity categories from a literature review, expert panel input and statistical models in generalized anxiety disorder: no or minimal 7 or below, mild 8 to 14, moderate 15 to 23, severe 24 or above, and advised caution.
  • Reliability is acceptable with a structured interview and falls without one. Studies show that the scale's discrimination between anxiety and depression is limited, and that somatic items are sensitive to side effects.
Source, license and referencesWhere it comes from

The Hamilton Anxiety Rating Scale was published by Max Hamilton in 1959 and is widely reproduced in the public domain. Item symptom lists follow the published scale.

  1. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-55.
  2. Matza LS, Morlock R, Sexton C, Malley K, Feltner D. Identifying HAM-A cutoffs for mild, moderate, and severe generalized anxiety disorder. Int J Methods Psychiatr Res. 2010;19(4):223-232.
  3. 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):61-68.

Clinical decision support, not a diagnosis. Each calculator scores a published scale the way its authors intended. A score informs a clinical interview and examination and never replaces them. If you are a patient using this page, please review the result with your clinician. In an emergency, call 911 or call or text 988 in the United States.