The Hamilton Anxiety Rating Scale

The Hamilton anxiety rating scale (HARS) was developed as a tool to be used by doctors and therapists to determine the severity of a patient’s anxiety. The system used is a 14 point questionnaire that covers each of the possible symptoms a patient may experience.  The first thirteen of these questions are answered by the therapist based on interviews and questions asked, whereas the last question is used by the therapists to show how they feel the patient is actually doing.

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The HARS was developed in 1959 by Max Hamilton as a way to help measure a patients anxiety levels at both the psychic or mental level and the somatic or physical level.  The test can be used on children and younger adults although there has also been recent support for its use in older patients.  The test itself was developed using the statistical technique of factor analysis which allowed Hamilton to create a list of the symptoms related to anxiety and then break them down into mental and physical symptoms.

The test is administered by the doctor or therapist who asks the patients the corresponding questions on the questionnaire and then rates their answers on a scale from 0-4 with four being the highest level of anxiety.  Upon completion of the test, the numbers are added up with the total being used to give the therapist a general idea of just how severe the patient’s anxieties are.  The questions are split into seven for psychic anxieties and seven for somatic anxieties giving the therapist a well rounded look at the patient and making it easier to understand their level of anxiety.

When the results are tallied, if the total is less than 17 a person is deemed to suffer from mild anxiety that can most likely be addressed with therapy.  However this is not necessarily the case.  Often a patient may be embarrassed by their anxiety problems and try to cover up or hide their true feelings. It takes a well trained therapist to coax the real answers out and to be able to make an accurate diagnosis. Scores from 18-24 show a moderate level of anxiety, this degree of anxiety can be handled by teaching the patient coping techniques such as meditation and breathing exercises.   Anything over 25 indicates severe anxiety.  This level of anxiety may require medication to help bring the anxiety under control well enough that the patient can then learn to use relaxation techniques and programs like CBT overcome their anxieties once and for all. 

While the test is useful to help therapists to understand a patient’s level of anxiety, it is only as good as the skills of the therapist and the answers are very much subject to interpretation.  The questions themselves are designed not only to reflect the answers from the patient but also how the therapist feels about the answers.  This can lead to a certain margin for error but overall the test has been proven to work quite well.  However questions have been raised regarding the similarity between the responses by those who suffer from anxiety and those who suffer from depression, since those who suffer from depression often score high on the HARS test.

Despite the possibility of skewed results, the Hamilton anxiety rating scale is still the most popular test used to evaluate patients in use today.  Over the years it has been shown to provide the most accurate results on a consistent basis.  The results from this test are then used with great success to help the patient understand and then overcome their anxieties once and for all.