Table 7.10-7.

Hamilton Rating Scale for Anxiety

Instructions: This checklist is to assist the physician or psychiatrist in evaluating each patient as
to his degree of anxiety and pathological condition. Please fill in the appropriate rating:
NONE = 0 MILD = 1 MODERATE = 2 SEVERE = 3 SEVERE, GROSSLY DISABLING = 4
Item RatingItem Rating
Anxious Worries, anticipation of _____ Somatic Tinnitus, blurring of vision, _____
the worst, fearful (sensory) hot and cold flushes, feelings
anticipation, irritability of weakness, pricking
sensation
Tension Feelings of tension, _____ Cardiovascular Tachycardia, palpitations, _____
fatigability, startle symptoms pain in chest, throbbing of
response, moved to vessels, fainting feelings,
tears easily, trembling, missing beat
feelings of restlessness,
inability to relax
Fears Of dark, of strangers, _____ Respiratory Pressure or constriction in _____
of being left alone, of symptoms chest, choking feelings,
animals, of traffic, of sighing, dyspnea
crowds
Insomnia Difficulty in falling _____ Gastrointestinal Difficulty in swallowing, _____
asleep, broken sleep, symptoms wind, abdominal pain,
unsatisfying sleep and burning sensations,
fatigue on waking, abdominal fullness, nausea,
dreams, nightmares, vomiting, borborygmi,
night terrors looseness of bowels, loss of
weight, constipation
Intellectual Difficulty in _____ Genitourinary Frequency of micturition, _____
(cognitive) concentration, poor symptoms urgency of micturition,
memory amenorrhea, menorrhagia,
development of frigidity,
premature ejaculation, loss of
libido, impotence
Depressed Loss of interest, lack of _____ Autonomic Dry mouth, flushing, pallor, _____
mood pleasure in hobbies, symptoms tendency to sweat, giddiness,
depression, early tension headache, raising of
waking, diurnal swing hair
Somatic Pains and aches, _____ Behavior at Fidgeting, restlessness or _____
(muscular) twitching, stiffness, interview pacing, tremor of hands,
myoclonic jerks, furrowed brow, strained face,
grinding of teeth, sighing or rapid respiration,
unsteady voice, facial pallor, swallowing,
increased muscular belching, brisk tendon jerks,
tone dilated pupils, exophthalmos
ADDITIONAL COMMENTS:
Investigator's signature:
(From Hamilton M: The assessment of anxiety states by rating. Br J Psychiatry. 1959;32:50,
with permission.)

Hamilton Anxiety Rating Scale

The HAM-A (Table 7.10-7) was developed in the late 1950s to assess anxiety symptoms,
P.1050

both somatic and cognitive. Because the conceptualization of anxiety has changed considerably,
the HAM-A provides limited coverage of the worry required for a DSM-IV diagnosis of
generalized anxiety disorder and does not include the episodic anxiety found in panic disorder.
There are 14 items, each of which is rated from 0 to 4 on an unanchored severity scale, with the
total score ranging from 0 to 56. A score of 14 has been suggested as the threshold for clinically
significant anxiety, but scores of 5 or less are typical in individuals in the community. The scale
is designed to be administered by a clinician, and formal training or the use of a structured
interview guide is required to achieve high reliability. A computer-administered version is also
available. Reliability is fairly good based on internal consistency, interrater, and testretest
studies. However, given the lack of specific anchors, reliability should not be assumed to be high
across different users in the absence of formal training. Validity appears good based on
correlation with other anxiety scales but is limited by the relative lack of coverage of domains
critical to the modern understanding of anxiety disorders. Even so, the HAM-A has been used
extensively to monitor treatment response in clinical trials of generalized anxiety disorder and
may also be useful for this purpose in clinical settings.