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Criticisms
Issues that arise when using Hamilton Anxiety Rating Scale (HAM-A) have to do with how the clinician interprets the results, changes in the classification of anxiety disorder, symptoms being assessed, and newer measurements that may be more suitable for the particular subject.

Clinician's administer HARS and may influence the subject by how they explain the question. Interpretation of the subjects response may also be hindered by the clinician even when methods are present to prevent interviewer biases.

HAM-A was created before the DSM-III which changed generalized anxiety disorder into a disorder of worry (which is not covered by HAM-A). DSM-VI defined generalized anxiety disorder as excessive and uncontrollable worry in which HAM-A doesn't accurately cover the main symptom (worry). Symptoms that HAM-A addresses are respiratory, cardiovascular, and gastrointestinal which are not included in the DSM-IV associated symptoms of generalized anxiety disorder. The current HAM-A scale is poor at showing a difference between generalized anxiety disorder and depression due to changes in the DSM, newer measurements, and possible clinician error.

Computer administered Hamilton Anxiety Rating Scale has shown to be almost as effective as the clinician-administered version. There was a mean score difference between the two forms that would be considered statistically significant but not clinically. This statistical significance was not found in the mean score difference in subjects with anxiety disorders. Another area that showed a significant difference was in variance scores (this was found in both forms). Other disadvantages of using a computer for the HAM-A include, "difficulty in evaluating nonverbal symptomatology, and patient's reactions to being interviewed by a computer. Although reactions to being interviewed by the computer were generally positive, most subjects preferred being interviewed by the clinician (Kobak, Reynolds, & Greist, 1992)." One of the biggest drawbacks of taking the HAM-A on a computer is the loss of nonverbal body language in which the clinician would normally be able to take into account when looking at the scores. (Kobak, Reynolds, & Greist, 1993)

1. The author's disclosures accompany the original article.

2. This letter (doi: 10.1176/appi.ajp.2009.09091254r) was accepted for publication in October 2009

3. Leichsenring, F. (2006). Cognitive-Behavioral Therapy and Psychodynamic Psychotherapy: Techniques, Efficacy, and Indications. American Journal Of Psychotherapy, 60(3), 233.