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Hamilton Anxiety Rating Scale

1. Anxious Mood: Worries, apprehension, feeling that the worst is about to happen, easily irritable.
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1. Anxious Mood: Worries, apprehension, feeling that the worst is about to happen, easily irritable.
No symptoms
Mild
Moderate
Severe
Very severe
2. Tension: Feeling tense, easily fatigued, unable to relax, emotional responses, easily cries, trembles, feels uneasy.
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2. Tension: Feeling tense, easily fatigued, unable to relax, emotional responses, easily cries, trembles, feels uneasy.
No symptoms
Mild
Moderate
Severe
Very severe
3. Fears: Fear of dark, strangers, being alone, animals, traveling, or crowded places.
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3. Fears: Fear of dark, strangers, being alone, animals, traveling, or crowded places.
No symptoms
Mild
Moderate
Severe
Very severe
4. Insomnia: Difficulty falling asleep, frequent waking, shallow sleep, nightmares, night terrors, waking up feeling tired.
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4. Insomnia: Difficulty falling asleep, frequent waking, shallow sleep, nightmares, night terrors, waking up feeling tired.
No symptoms
Mild
Moderate
Severe
Very severe
5. Cognitive Function: Also called memory or attention deficits. Difficulty concentrating, poor memory.
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5. Cognitive Function: Also called memory or attention deficits. Difficulty concentrating, poor memory.
No symptoms
Mild
Moderate
Severe
Very severe
6. Depressed Mood: Loss of interest, inability to enjoy previously enjoyed activities, depression, early waking, feeling worse in the morning than at night.
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6. Depressed Mood: Loss of interest, inability to enjoy previously enjoyed activities, depression, early waking, feeling worse in the morning than at night.
No symptoms
Mild
Moderate
Severe
Very Severe
7. Somatic Anxiety (Muscular Symptoms): Muscle aches, stiffness, frequent muscle twitching, jerking of limbs, teeth chattering, shaky voice.
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7. Somatic Anxiety (Muscular Symptoms): Muscle aches, stiffness, frequent muscle twitching, jerking of limbs, teeth chattering, shaky voice.
No symptoms
Mild
Moderate
Severe
Very Severe
8. Sensory System Symptoms: Blurred vision, chills and fever, weakness, tingling sensations all over the body.
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8. Sensory System Symptoms: Blurred vision, chills and fever, weakness, tingling sensations all over the body.
No symptoms
Mild
Moderate
Severe
Very Severe
9. Cardiovascular System Symptoms: Rapid heartbeat, palpitations, chest pain, a feeling of blood pulsating, fainting sensations, skipped heartbeats.
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9. Cardiovascular System Symptoms: Rapid heartbeat, palpitations, chest pain, a feeling of blood pulsating, fainting sensations, skipped heartbeats.
No symptoms
Mild
Moderate
Severe
Very Severe
10. Respiratory System Symptoms: Frequent feelings of chest tightness, shortness of breath, sighing, difficulty breathing.
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10. Respiratory System Symptoms: Frequent feelings of chest tightness, shortness of breath, sighing, difficulty breathing.
No symptoms
Mild
Moderate
Severe
Very Severe
11. Gastrointestinal Symptoms: Difficulty swallowing, belching, poor appetite, indigestion (stomach pain after meals, burning stomach pain, bloating, nausea, fullness), bowel sounds, diarrhea, weight loss, constipation.
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11. Gastrointestinal Symptoms: Difficulty swallowing, belching, poor appetite, indigestion (stomach pain after meals, burning stomach pain, bloating, nausea, fullness), bowel sounds, diarrhea, weight loss, constipation.
No symptoms
Mild
Moderate
Severe
Very Severe
12. Genitourinary System Symptoms: Frequent urination, urgency, missed periods, lack of sexual desire, premature ejaculation, erectile dysfunction, impotence.
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12. Genitourinary System Symptoms: Frequent urination, urgency, missed periods, lack of sexual desire, premature ejaculation, erectile dysfunction, impotence.
No symptoms
Mild
Moderate
Severe
Very Severe
13. Autonomic nervous system symptoms: dry mouth, flushing, pallor, easy sweating, goosebumps, tension headaches, hair standing up.
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13. Autonomic nervous system symptoms: dry mouth, flushing, pallor, easy sweating, goosebumps, tension headaches, hair standing up.
No symptoms
Mild
Moderate
Severe
Very severe
14. Behavioral performance during conversation: (1) General performance: tension, inability to relax, nervousness, biting fingernails, clenched fists, fiddling with a handkerchief, facial muscle twitching, foot tapping, trembling hands, frowning, stiff expressions, high muscle tension, sighing breath, pale complexion; (2) Physiological performance: swallowing, frequent hiccups, rapid heart rate at rest, accelerated breathing (over 20 breaths per minute), heightened tendon reflexes, tremors, dilated pupils, eyelid twitching, easy sweating, protruding eyeballs.
Please select
14. Behavioral performance during conversation: (1) General performance: tension, inability to relax, nervousness, biting fingernails, clenched fists, fiddling with a handkerchief, facial muscle twitching, foot tapping, trembling hands, frowning, stiff expressions, high muscle tension, sighing breath, pale complexion; (2) Physiological performance: swallowing, frequent hiccups, rapid heart rate at rest, accelerated breathing (over 20 breaths per minute), heightened tendon reflexes, tremors, dilated pupils, eyelid twitching, easy sweating, protruding eyeballs.
No symptoms
Mild
Moderate
Severe
Very severe
Score:

Result Interpretation

HAMA should be jointly assessed by two trained evaluators, generally using conversation and observation methods. After the assessment is completed, the two evaluators independently score. When evaluating the improvement in anxiety symptoms before and after psychological or medication intervention, first evaluate the situation at enrollment or the week before, then re-evaluate after 2-6 weeks of intervention to compare the severity of anxiety symptoms and the change in symptom spectrum.

1. Anxiety factor analysis: HAMA divides anxiety factors into two main categories: somatic and psychic. Somatic anxiety: scores from items seven to thirteen are higher. Psychic anxiety: scores from items one to six and fourteen are higher.

2. The total HAMA score can reflect the severity of anxiety symptoms well. The total score can be used to assess the severity of anxiety symptoms in patients with anxiety and depression disorders and evaluate the effectiveness of various drug and psychological interventions. According to data provided by the Chinese Scale Collaboration Group: A total score ≥29 indicates severe anxiety; ≥21 indicates significant anxiety; ≥14 indicates anxiety; a score exceeding 7 indicates possible anxiety; if less than 7, there are no anxiety symptoms.

The analysis of the two major factors of HAMA, somatic and psychic, can not only specifically reflect the patient's psychopathological characteristics but also reflect the treatment effects on target symptom groups.

The Hamilton Anxiety Scale (HAMA), compiled by Hamilton in 1959, is one of the commonly used scales in psychiatric clinical practice. It includes 14 items. The "CCMD-3 Chinese Diagnostic Criteria for Mental Disorders" lists it as an important diagnostic tool for anxiety disorders. It is often used in clinical practice to diagnose and classify the severity of anxiety disorders.

It is mainly used to assess the severity of anxiety symptoms in patients with neurosis and other conditions. However, it is less suitable for estimating the anxiety state in various mental illnesses. Also, compared to the Hamilton Depression Scale (HAMD), there are overlapping items such as depressive mood, somatic anxiety, gastrointestinal symptoms, and insomnia, making it difficult to distinguish between anxiety and depression disorders.

References

Research Paper Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-5.