HAM-A

The Hamilton Anxiety Rating Scale (HAM-A) is a widely used clinical assessment tool for quantifying the severity of an individual’s anxiety. Developed by Max Hamilton in 1959, it is one of the first rating scales designed to measure the severity of anxiety symptoms, and it remains a standard tool used in both clinical and research settings.

The HAM-A consists of 14 items, each of which is designed to assess a different aspect of anxiety. These items cover both psychological (mental) and somatic (physical) symptoms of anxiety. Each item is scored on a scale from 0 to 4, based on the severity and frequency of the symptoms:

  • 0: Not present.
  • 1: Mild.
  • 2: Moderate.
  • 3: Severe.
  • 4: Very severe.

The 14 items include:

  1. Anxious Mood: Worries, anticipation of the worst, fearful anticipation, irritability.
  2. Tension: Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.
  3. Fears: To specific objects or situations, response to phobias.
  4. Insomnia: Difficulty in falling asleep, broken sleep, unsatisfactory sleep and fatigue on waking, dreams, nightmares, night terrors.
  5. Intellectual (Cognitive): Difficulty in concentration, poor memory.
  6. Depressed Mood: Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.
  7. Somatic (Muscular): Muscle aches and pains, stiffness, myalgia, twitching, grinding of teeth, unsteady voice.
  8. Somatic (Sensory): Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
  9. Cardiovascular Symptoms: Palpitations, throbbing of vessels, precordial pain, palpitation, headaches.
  10. Respiratory Symptoms: Pressure or constriction in chest, choking feeling, sighing, dyspnea.
  11. Gastrointestinal Symptoms: Difficulty in swallowing, wind, abdominal pain, burning sensation, constipation, nausea, belching.
  12. Genitourinary Symptoms: Frequency of urination, urgency of urination, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.
  13. Autonomic Symptoms: Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache.
  14. Behavior at Interview: Fidgeting, restlessness, plucking at clothes, hair, etc., mannerisms, look of apprehension.

The total score, which can range from 0 to 56, indicates the severity of the patient’s anxiety:

  • 0-17: Mild anxiety.
  • 18-24: Mild to moderate anxiety.
  • 25-30: Moderate to severe anxiety.
  • Over 30: Severe anxiety.

The HAM-A is particularly useful because it addresses both the psychological and physical symptoms of anxiety. It’s often used before starting treatment to establish a baseline level of anxiety and then periodically during treatment to monitor progress. However, like any such tool, it should be used as part of a comprehensive assessment that includes a detailed patient history and clinical evaluation.