> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # HAM-A — Hamilton Anxiety Rating Scale > The 14-item clinician-administered anxiety severity scale, split across psychic and somatic subscales. The HAM-A is the dominant anxiety severity rating in clinical trials. You fill it about the client after a structured interview. The client never sees the form. It's frequently paired with the HAM-D in mixed depression-and-anxiety presentations, and is the standard outcome scale in SSRI, SNRI, and buspirone trials. ## What it measures Fourteen items split into two subscales: * **Psychic anxiety** (items 1-7): anxious mood, tension, fears, insomnia, cognitive symptoms, depressed mood, somatic muscular tension * **Somatic anxiety** (items 8-14): sensory symptoms, cardiovascular, respiratory, gastrointestinal, genitourinary, autonomic, behavior at interview Each item scores 0-4 (Not present / Mild / Moderate / Severe / Very severe — incapacitating). Total range is 0-56. ## When to use it * Anxiety disorder severity tracking — GAD, panic disorder, PTSD-comorbid anxiety * Benzodiazepine taper monitoring * Treatment-response measurement in SSRI, SNRI, and buspirone trials * Mixed depression-and-anxiety presentations, paired with HAM-D For routine therapy monitoring, the GAD-7 self-report is usually the right tool — it's shorter, the client engages with the score, and the psychometrics hold up. The HAM-A earns its cost when you need rater anchors: trial protocols, complex presentations, or contexts where self-report is unreliable. ## How you fill it Solo fill. Open **HAM-A** from the templates picker and tap **New response**. The renderer walks you through each item with the SIGH-A (Shear et al. 2001) anchor language in the answer options. Typical administration time is 15-25 minutes. The form never goes to the client. The picker has no "Send to client" option for this measure. ## Scoring and severity cutoffs ### Total + subscales * **Total:** sum of all 14 items, 0-56 * **Psychic anxiety subscale:** sum of items 1-7, 0-28 * **Somatic anxiety subscale:** sum of items 8-14, 0-28 ### Severity bands (Maier et al. 1988) | Total | Band | | ----- | ------------------ | | `<17` | Mild | | 18-24 | Mild-to-moderate | | 25-30 | Moderate-to-severe | | ≥31 | Severe | ### Clinical change thresholds * **Response:** ≥50% reduction in total from baseline * **Remission:** total ≤7 sustained ## Rater training The Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A, Shear et al. 2001) provides standardized probe questions. Inter-rater reliability with trained raters typically ranges ICC 0.74-0.96. ## What we render vs. the source Verbatim Hamilton 1959 items with the SIGH-A anchor descriptors in the answer options. Item 7 ("somatic muscular") and item 8 ("somatic sensory") may seem misaligned to the psychic/somatic subscale split — that's the canonical Hamilton 1959 split per Maier 1988, and Rivet surfaces it as the standard subscale division. ## Known limitations * The 0-4 scale doesn't distinguish well between items rated for frequency vs. intensity vs. duration. Clinical judgment for borderline ratings. * Items 12 (genitourinary) and 13 (autonomic) overlap substantially with depression symptoms. The scale doesn't differentiate well between anxious depression and pure anxiety — pair with HAM-D for disambiguation. * Item 14 (behavior at interview) is the only direct-observation item. The others rely on patient report. ## HAM-A vs GAD-7 and the BAI The HAM-A is rated by you during a structured interview; the [GAD-7](/clinical-templates/screening/gad-7) is filled in by the client. That difference drives everything else. The HAM-A gives you fourteen items split into psychic and somatic anxiety and is the scale treatment trials report, which makes it the better fit for tracking response to a medication change or a benzodiazepine taper. The GAD-7 takes two minutes, can go out ahead of a session, and is what a referrer recognises. It also costs your time rather than the client's, and reliable scoring depends on rater familiarity — the structured interview guide exists for exactly that reason. Against the BAI: the Beck Anxiety Inventory is the self-report scale most often set beside the HAM-A in the literature. It is licensed by Pearson and paid for per use, so Rivet doesn't include it. If you want a self-report anxiety measure here, the GAD-7 is the one to use. ## Is it free to use? **Yes — it is public domain.** Hamilton, 1959. ## Citations * Hamilton, M. (1959). "The assessment of anxiety states by rating." *British Journal of Medical Psychology,* 32(1): 50-55. Public domain. * 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): 61-68. * Shear, M. K., Vander Bilt, J., Rucci, P., et al. (2001). "Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A)." *Depression and Anxiety,* 13(4): 166-178. ## Related articles The Hamilton Depression Rating Scale. Most often paired with HAM-A in mixed depression/anxiety presentations. Why these six measures don't ship to clients, and how solo fill works.