Hamilton Anxiety Rating Scale (HAM-A)

Description

Hamilton Anxiety Rating Scale is one of the earliest scales that was developed. Unlike many

other psychological scales, the HAM-A does not include prompt questions. The scale has 14

groups, each assessing domains that are associated with anxiety. Each group has a number of

symptoms within it, and the clinician rates the items on a scale between 0 and 4, with 4 being

the most severe presentation. The individual scores are then summed up to provide the final

rating of anxiety. Scores of 17 or less indicate mild severity, those between 18 and 24 indicate

mild to moderate severity, and those of 25 and above indicate moderate to severe anxiety

(Hamilton, 1959).

Development

HAM-A was developed by Max Hamilton as a method to differentiate anxiety as a pathological

mood condition from anxiety as a state, the latter which he termed as “anxiety neurosis”. To

develop the scale, Hamilton collected a variety of symptoms relevant to anxiety and then

grouped them together to form the domain-specific groups that exist currently (Hamilton,

1959).

Psychometric properties

Maier, Buller, Philipp, & Heuser (1988) tested the psychometric properties of HAM-A on groups

of 97 individuals with anxiety and 101 individuals with depression. They reported that the

reliability and concurrent validity of the HAM-A and its subscales were sufficient. Furthermore,

there is reasonable inter-rater reliability and good one-week retest reliability.

Application

According to Hamilton, the scale is used to measure the level of anxiety neurosis, which

indicates a pervasive anxious state rather than anxiety as a normal reaction to danger or anxiety

as a pathological condition (Hamilton, 1959). The scale should not be used as a diagnostic tool,

but rather to assess the extent of anxiety within individuals already known to suffer from

anxiety neurosis.
 References

Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical

Psychology, 32, 50-55.

Maier, W., Buller, R., Philipp, M., & Heuser, I. (1988). The Hamilton Anxiety Scale: reliability,

validity and sensitivity to change in anxiety and depressive disorders. Journal of Affective

Disorders, 14(1), 62-68.

 Proforma of the client

Name- PT

Age- 21

Gender- Female

Education- Currently pursuing postgraduate education

Presenting concerns- Anxiety about almost everything in general, excessive worry which is

irrational.

Test administered- Hamilton Anxiety Rating Scale

Purpose of testing- To assess the level of anxiety of the client

Behavioural observations-

● Appearance and grooming- Properly dressed and groomed. Hair combed.

● Psychomotor activity- Normal and no signs of tics or mannerisms. No psychomotor

agitation or retardation was observed.

● Speech- Client's speech was spontaneous, coherent, had proper intonations, and was

rich in content. She could answer the questions posed, and could elaborate her

responses when requested to do so.

● Eye contact- The client made appropriate eye contact throughout the sessions

Test results

The client had the following scores on the 14 domains-

1. Anxious mood- 1

2. Tension- 1

3. Fears- 1
 4. Insomnia- 0

5. Intellectual- 0

6. Depressed mood- 0

7. Somatic (muscular)- 1

8. Somatic (sensory)- 0

9. Cardiovascular symptoms- 1

10. Respiratory symptoms- 1

11. Gastrointestinal symptoms- 1

12. Genitourinary symptoms- 0

13. Autonomic symptoms- 1

14. Behaviour at interview- 0

The final score for the client on the scale was 8.

Test interpretation

The score of 8 indicates that the client has mild anxiety.

Impression and recommendation

The client has been in therapy for quite some time now and the improvement is visible in the

form of a low test score. The therapist and the client would need to work further to consolidate

the gains made in therapy.