HAM-A Test — Hamilton Anxiety Rating Scale (14-Item Clinical Anxiety Assessment)
The Hamilton Anxiety Rating Scale — the clinician-administered anxiety severity standard since 1959. 14 items, 8 minutes, instant score bands. Free in the Mindtalk app.
Clinically reviewed by Dr. Vishal Kasal, MD in Psychiatry, MBBS. Last reviewed 2026-09-25.
Important safety information
The HAM-A includes a question about thoughts of self-harm (question 9). If you have had any such thoughts recently, please reach out for support before or instead of taking this assessment — you do not need to take a test to deserve help.
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The 14 HAM-A items
The scale asks you to rate each anxiety symptom's severity over the past week on a 0-4 scale:
0 = Not present · 1 = Mild · 2 = Moderate · 3 = Severe · 4 = Very severe
The 14 items are grouped into two clusters:
Psychic anxiety (items 1-6, 14):
- Anxious mood — worries, anticipation of the worst
- Tension — feelings of tension, fatigability, startle, easily moved to tears
- Fears — of the dark, strangers, being alone, animals, traffic, crowds
- Insomnia — difficulty falling asleep, disturbed sleep, unsatisfying sleep and fatigue on waking, nightmares
- Intellectual — difficulty concentrating, poor memory
- Depressed mood — loss of interest, lack of pleasure in hobbies, depression, early waking, mood variation
- Behaviour at interview — fidgeting, restlessness, hand tremor, furrowed brow, strained face, sighing, pale face
Somatic anxiety (items 7-13): 7. Muscular — muscle aches, muscle stiffness, teeth grinding, unsteady voice 8. Sensory — tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, prickling sensation 9. Cardiovascular — tachycardia, palpitations, chest pain, throbbing of vessels, fainting feelings 10. Respiratory — pressure or constriction in chest, choking feelings, sighing, dyspnoea 11. Gastrointestinal — difficulty swallowing, gas, abdominal pain, burning sensations, fullness, nausea, vomiting, borborygmi, looseness of bowels, weight loss, constipation 12. Genitourinary — frequency of urination, urgency of urination, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence 13. Autonomic — dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair
Total ranges 0-56.
HAM-A severity band table
The cut-offs below come from Matza et al. (2010), who tested them against clinicians' global severity ratings. The study defined 24 or more as severe; the 31+ row is Mindtalk's practical flag for very high scores, not a published band.
| Score | Severity | What it means | Suggested next step |
|---|---|---|---|
| 0-7 | No / minimal anxiety | Typical for everyday life | Continue self-monitoring |
| 8-14 | Mild anxiety | Symptoms present but not majorly impairing | Lifestyle, therapy if persistent; retake in 2-4 weeks |
| 15-23 | Moderate anxiety | Symptoms causing clear impairment | Clinical evaluation; CBT often indicated |
| 24-30 | Severe anxiety | Significant impairment across areas | Clinical evaluation this week; consider combined therapy + medication |
| 31+ | Severe (very high) | Major impairment, often disabling | Urgent clinical evaluation |
How the HAM-A was developed
The HAM-A was developed by Max Hamilton (creator of the HAM-D as well) at the University of Leeds in 1959. It was the first standardised clinician-rated anxiety severity scale, designed for use in the emerging RCT era of anxiety pharmacotherapy. The 14-item structure with psychic + somatic clusters emerged from Hamilton's factor analysis of clinical anxiety presentations and has remained essentially unchanged.
The HAM-A has been a standard outcome measure in anxiety medication trials for decades, including trials of benzodiazepines, buspirone, SSRIs, SNRIs and pregabalin. When a psychiatric paper reports that a drug reduced anxiety, the HAM-A is often the measure.
Validation and evidence
Hamilton introduced the scale in 1959 as a clinician's rating of anxiety states [1]. Because the original lacked administration instructions and clear anchors, Shear and colleagues developed the Structured Interview Guide (SIGH-A); in videotaped interviews with 89 participants across three anxiety research sites, both the traditional and structured formats showed high inter-rater and test-retest reliability, with the structured version scoring about 4.2 points higher on average [2]. Matza and colleagues then defined severity cut-offs using data from 144 patients in a generalised anxiety disorder trial: 8-14 mild, 15-23 moderate and 24 or more severe, with 7 or less representing no or minimal anxiety; these ranges closely matched clinicians' global severity ratings, though the authors advised validating them in larger samples [3].
If your score is in the moderate or severe range, read about anxiety disorders and how cognitive behavioural therapy (CBT) and medication are combined.
References
- Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-55. PubMed
- Shear MK, Vander Bilt J, Rucci P, et al. Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A). Depress Anxiety. 2001;13(4):166-178. PubMed
- Matza LS, Morlock R, Sexton C, Malley K, Feltner D. Identifying HAM-A cutoffs for mild, moderate, and severe generalized anxiety disorder. Int J Methods Psychiatr Res. 2010;19(4):223-232. PubMed
HAM-A vs other anxiety scales
| Test | Items | Time | Administered by | Best for |
|---|---|---|---|---|
| HAM-A | 14 | 8 min | Clinician (self-admin adapted) | Severity + medication response tracking |
| GAD-7 | 7 | 2 min | Self-report | Screening + primary-care monitoring |
| STAI | 40 | 8 min | Self-report | State vs trait anxiety split |
| BAI | 21 | 5 min | Self-report | Somatic-heavy anxiety severity |
| DASS-21 (Anxiety) | 7 | 2 min | Self-report | Combined with depression + stress |
Use HAM-A when you need a clinician-quality severity score. Use GAD-7 for screening. Use STAI when you need to separate current-state from long-standing-trait anxiety.
When to act on your HAM-A result
- 0-7: No action. Retake if new stressors arise.
- 8-14 (mild): Behavioural activation, sleep hygiene, mindfulness. The CBT Thought Record and Progressive Muscle Relaxation are evidence-based. Retake in 2-4 weeks.
- 15-23 (moderate): Clinical evaluation. CBT is first-line; SSRI may be added if symptoms persist. Book a Mindtalk psychiatrist or psychologist.
- 24-30 (severe): Clinical evaluation this week. Combined CBT + medication often indicated. Consider the 90-day Anxiety Loop Breaker programme.
- 31+ (very severe): Urgent clinical evaluation. Full assessment for anxiety subtype, comorbidities, and functional impairment.
- High somatic + low psychic pattern: Rule out cardiac, thyroid, and vestibular causes. HAM-A cannot distinguish somatic anxiety from underlying medical causes.
After the HAM-A
- Track over time. Retake every 2-4 weeks during treatment. The psychic and somatic clusters often respond at different rates.
- Pair with self-report. Use GAD-7 for weekly self-monitoring alongside HAM-A for monthly clinician review.
- Assess comorbid depression. Anxiety and depression often occur together. Take the PHQ-9 alongside.
- Structured programme. The 90-day Anxiety Loop Breaker is calibrated for HAM-A scores in the 15-25 range.
- Book a specialist. Mindtalk's psychiatrists and psychologists treat anxiety presentations across Bangalore, Hyderabad, Mysore, and online for anywhere in India.
How to take the HAM-A
- 1
Open the HAM-A in the Mindtalk app
Tap "Take the HAM-A" to open the self-administered adaptation. You will need a free Mindtalk account — sign-in takes under a minute.
- 2
Answer the 14 items
Rate each of the 14 anxiety symptoms on a 0-4 severity scale over the past week. The app groups items into psychic and somatic clusters so you can see which drives your score.
- 3
Get your total, sub-cluster split, and severity band
Receive a total 0-56 score, psychic vs somatic split, severity band, and a personalised next-step recommendation. High somatic scores route to consideration of medical rule-outs; high psychic scores route to psychotherapy planning.
Related assessment guides
BAI (explained) → GAD-7 alternative
The Beck Anxiety Inventory — the classic 21-item somatic-focused anxiety measure. Learn what it is, and take the free GAD-7 alternative in the Mindtalk app.
Read the guide →GAD-7
The most widely used anxiety screener in clinical practice. 7 questions, 2 minutes, instant score with a personalised next-step recommendation. Free in the Mindtalk app.
Read the guide →PANC
Are you having panic attacks? Test whether the pattern fits Panic Disorder criteria in 3 minutes. Free in the Mindtalk app.
Read the guide →PSWQ
The Penn State Worry Questionnaire — the standard measure of trait pathological worry. 16 items, 4 minutes, instant clinical bands. Free in the Mindtalk app.
Read the guide →SIAS
The Social Interaction Anxiety Scale — the standard measure of anxiety in one-on-one and small-group interaction. 20 items, 4 minutes. Free in the Mindtalk app.
Read the guide →SPIN
The Social Phobia Inventory — the standard self-report scale for social anxiety disorder. 17 items, 4 minutes, instant clinical bands. Free in the Mindtalk app.
Read the guide →Frequently Asked Questions
- How accurate is the HAM-A?
- The HAM-A has been a standard anxiety severity measure for over 65 years. With trained raters or the Structured Interview Guide (SIGH-A), inter-rater and test-retest reliability are high, and it is sensitive to change in medication trials. Its main limitation is that it was designed for clinician administration; self-rated adaptations follow the same structure but can miss details a trained clinician would probe.
- HAM-A vs GAD-7 — when to use which?
- The GAD-7 is a self-report screener designed for primary care — 7 items, 2 minutes, focused specifically on generalized anxiety. The HAM-A is a clinician-administered severity measure across all anxiety subtypes — 14 items, 8 minutes, richer coverage of somatic symptoms. Rule of thumb: use GAD-7 for screening and quick treatment monitoring; use HAM-A when you need a formal severity score, when tracking medication response, or when generalized anxiety and panic overlap.
- What are the HAM-A severity bands?
- The validated cut-offs, from a 2010 study of 144 people with generalised anxiety disorder, are 0-7 no or minimal anxiety, 8-14 mild, 15-23 moderate and 24 or more severe. They closely matched clinicians' global severity ratings. Older, informal bands (such as 17 or under as mild) still circulate online, but the 2010 cut-offs are the ones the Mindtalk app uses.
- Why does the HAM-A include somatic items?
- Because anxiety is not only mental — physical symptoms (racing heart, sweating, GI upset, muscle tension, dizziness) are a defining feature and often the reason people first seek help. Hamilton deliberately split the scale into psychic + somatic clusters so clinicians could see the balance. A high somatic + moderate psychic pattern often flags panic disorder or a medical rule-out; high psychic + low somatic often flags generalized anxiety or worry-dominant presentation.
- Is the HAM-A validated in India?
- The HAM-A is widely used in Indian psychiatric practice and research, including at Cadabams, for anxiety severity and medication-response tracking. Its cut-offs come from Western trial samples, and we are not aware of a large Indian study establishing separate cut-offs, so clinicians interpret scores alongside the full clinical picture.
- Should I take the HAM-A if I'm already taking a self-report scale like GAD-7?
- Only if the additional information would change treatment planning. If GAD-7 is showing clear treatment response and severity is stable, HAM-A adds little. If GAD-7 and clinical picture disagree (score says one thing, symptoms say another), if somatic symptoms are prominent, or if medication is being adjusted, HAM-A adds precision.
- How do I take the HAM-A?
- Click 'Take the HAM-A'. Complete the 14 items (6-8 minutes for the self-administered version), receive your total + psychic/somatic split + severity band, and get a personalised next-step recommendation. Free in the Mindtalk app.
- Is there a Hamilton Anxiety Rating Scale PDF?
- The HAM-A is in the public domain and all 14 items are listed on this page. Clinicians often use the Structured Interview Guide (SIGH-A), which adds standard questions and anchor points. When you complete the self-rated version in the Mindtalk app, you can show your results to your clinician at your consultation.
Need a clinician's read on your results?
A high score is a signal, not a diagnosis. Mindtalk's psychiatrists and clinical psychologists can interpret your results and recommend next steps — same-day appointments available.