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He included a distinction “between anxiety as a normal reaction to danger, anxiety as a pathological condition not related to stress, and anxiety as a state or broad syndrome that he termed “anxiety neurosis.’” Hamilton developed the scale to be used with patients already known to suffer from anxiety neurosis, not to be used as a means of diagnosing anxiety in patients with other disorders.

Although Hamilton developed the scale as a rating of severity, he used his scale to differentiate “anxiety as a pathological mood” from a “state (or neurosis).” He used common methods for designing the rating scale.

A variety of relevant symptoms were collected and divided into groups.

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All of the thirteen variables were described by succinct statements and included on a sheet that was used by an interviewer for assessing a patient.

The original version used a “five-point scale” for rating the groups of symptoms.

The first version of the scale was only a start, and as Hamilton stated, “Some of the variables are obviously a rag-bag of oddments and need further investigation.” He conducted tests on the original scale that initiated improvement and, over time, evolved the structure and scoring of the scale to its present state.

The Hamilton Anxiety Rating Scale (HAM-A) is a psychological questionnaire used by clinicians to rate the severity of a patient's anxiety.

Anxiety can refer to things such as “a mental state…a drive…a response to a particular situation…a personality trait…and a psychiatric disorder.” It was originally published by Max Hamilton in 1959.

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