How anxiety is diagnosed? | Hamilton Rating Scale Anxiety (HAM-A)

Patients with anxiety and depression are increasing in numbers in this modern livings. The reasons may be many. But a person suffering from these kinds of psychiatric problems must come out of it as early as possible. Because long-suffering from these issues may spoil their personal and social life as well as also affects their ability to concentrate on work and finally can create financial problems.

How anxiety is diagnosed? | Hamilton Rating Scale Anxiety (HAM-A)

The Hamilton Rating Scale for Anxiety (HAM-A)

It is the first assessment scale used to measure the severity of anxiety. It is a 14-point scale, used by experienced doctors and takes about 15-20 minutes to complete the interview or assessment of anxiety severity. It is not mainly used for diagnostic or screening tests purposes. But it is primarily useful for evaluating patient response or improvement to the treatment process. It can be used in adults, adolescents, and children also to evaluate the severity of anxiety.

Below is a list of phrases that describe people’s specific feelings. Marks or scores are given according to the patient’s answers to the extent that they best describe his or her condition. Each feeling or answered question is given a score on 5 point scale. Means choose one of five scores for each of the fourteen questions that are 0 to 4.

Here 0 = Absent or not present, 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Very Severe

Here is the list of all 14 items or you can say psychological feelings or symptoms that commonly appear in anxiety. Ask the patient and provide a score from 0 to 4 for each item according to how the patient describes their feelings.

(01) Anxious or Restless mood

Anxiety, perception of being bad, perception of fear, irritability

(02) Stress or tension

Feelings of stress, fatigue, startle or surprise response, crying easily, feelings of restlessness, inability to relax, trembling

(03) Fear

Fear of darkness, of strangers, of crowds, of traffic, of animals, of being alone

(04) Insomnia

Difficulty in sleeping, broken sleep, unsatisfactory sleep, and fatigue after waking up, nightmares, night terrors.

(05) Intellectual

Difficulty in concentration, poor memory

(06) Depressed mood

Decreased interest, lack of pleasure in hobbies, frustration, getting up early, diurnal swing

(07) Body-muscle feelings (Somatic-muscular)

Pain and tingling, contractions or twitching, joint stiffness, tremors, grinding of teeth, muscle jerks, unsteady sound, increase in muscular tone.

(08) Body-sensation (Somatic sensation)

Tinnitus (ringing or buzzing in the ears), blurred vision, feeling weak, pricking or burning sensation, cold and hot flushes.

(09) Symptoms related to blood vessels and heart (Cardiovascular symptoms)

Increased heart rate, palpitation, chest pain, throbbing veins, feelings of fainting, missing beats.

(10) Respiratory symptoms

Pressure or chest tightness, feelings of suffocation, deep breathing, shortness of breath.

(11) Digestive system

Difficulty in swallowing, flatulence, abdominal pain, burning sensation, bloated stomach, nausea, vomiting, intestinal relaxation, weight loss, constipation.

(12) Genital and urinary tract symptoms (Genitourinary symptoms)

Frequency and urgency for urination, lack of menstruation, abnormal excessive bleeding during menstruation, development of rigidity (sexual non-response), premature ejaculation, decreased libido, impotence.

(13) Autonomous symptoms

Dryness of mouth, flushing, paleness, a tendency to sweat, dizziness, stress, headache, hair growth.

(14) Behavior during the visit or interview

Feeling restless, restless or pacing, tremors of hands, wrinkled forehead, deep or rapid breathing, paleness of face, swallowing, etc.

Interpretation of Hamilton Rating scale for anxiety

Now add up your score against all 14 items you evaluated from the patient and compare this sum with the coefficient given in the table below.

For example, if your total score is 26 then you can be called moderate to severe anxiety.

Interpretation of HAM-A digits

Total score

Diagnosis of Anxiety


Mild anxiety


Mild to moderate anxiety


Moderate to severe anxiety

Mind Matters

Food is the most abused anxiety drug.

Exercise is the most underutilized Antidepressant.

Who created the hamilton anxiety rating scale?

Max R Hamilton is the first person who created the Hamilton rating scale for anxiety in 1959. He described anxiety as a broad syndrome or a state and named as “anxiety neurosis”. The main aim of this scale is to evaluate the patient from the effectiveness of the treatment, not to diagnose anxiety.

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