Family therapists, marriage and family counsellors, social workers, psychologists, family medicine physicians (for a 'medical genogram'), palliative care teams, addiction counsellors, and some primary care clinicians. The genogram was popularised by Monica McGoldrick and Randy Gerson's book 'Genograms in Family Assessment' (1985) and subsequent editions.

Clinical geneticists, genetic counsellors, cancer genetics services, reproductive genetics clinics, rare disease diagnostic teams, and research geneticists. Pedigrees are also used in biology teaching and in veterinary and animal-breeding contexts (with different symbol conventions).

Genogram vs Pedigree — What's the Difference? (2026)

Q: What is the difference between a genogram and a pedigree?

A pedigree is a clinical genetics diagram using standardised NSGC symbols to track biological relationships and heritable conditions across generations. A genogram is a family systems tool used in therapy, social work, and family medicine to capture biological relationships plus emotional bonds, conflicts, addictions, mental health history, and cultural context. Pedigrees emphasise genotype and inheritance; genograms emphasise relationships and psychosocial patterns. The underlying family structure diagram is similar, but the annotation layers differ significantly.

Q: Can you use a genogram in a clinical genetics setting?

Not typically. Clinical genetics services use pedigrees with NSGC-standard symbols because risk models, testing workflows, and interoperable records depend on that notation. A genogram's emotional-relationship symbols do not carry clinical meaning for Bayesian risk models and can crowd out the biological information needed for inheritance analysis. Some family medicine services use a 'medical genogram' — a hybrid that keeps biological structure plus medical history without the full family-therapy layer.

Q: Can one piece of software do both?

Some tools straddle the two — GenoPro is historically a genogram product that can be used to draw clinical pedigrees; Evagene is a clinical pedigree product with ancillary features (55+ allergies catalogue, 50+ trait catalogue, ancestry annotation) that cover some medical-genogram needs without the therapy-focused emotional-relationship symbols. The answer depends on which features matter most to your workflow.

Q: What is a 'medical genogram'?

A medical genogram is a family medicine variant that keeps the genogram's emphasis on family context but focuses on medical rather than purely psychosocial information — chronic conditions, mental health history, substance use, cause of death, age of onset for chronic disease. It sits between a pedigree and a family-therapy genogram and is often used by family physicians taking a longitudinal family history.

Q: Do genograms use the same symbols as pedigrees?

The core shapes (square, circle, diamond) and basic relationship lines (horizontal mating line, vertical descent, horizontal sibship line) are shared. Genograms extend this with additional symbols for emotional relationships — double lines for close bonds, jagged lines for conflict, broken lines for cut-offs — and for psychosocial annotations (addictions, abuse, mental health) that do not appear in clinical NSGC pedigrees.

Short version. Pedigrees and genograms both draw biological families as diagrams, using squares for males, circles for females, and lines for relationships. They differ in what they layer on top: a pedigree uses NSGC-standardised symbols to encode genotype, affected status, and inheritance pattern for a medical purpose; a genogram adds emotional-relationship symbols, addictions, cultural information, and psychosocial annotations for a family-systems purpose. Different audiences, different tools, different software. A pedigree is the tool for clinical genetics; a genogram is the tool for family therapy, social work, and some forms of family medicine.

What a pedigree is

A pedigree is a family-history diagram used in clinical genetics to document biological relationships and the distribution of heritable traits and conditions across generations. It follows the NSGC standardised nomenclature — squares, circles, diamonds, filled shapes for affected, arrow for proband, specific symbols for pregnancies, reproductive losses, twins, consanguinity, and adoption. The pedigree exists to support a specific clinical workflow: narrowing the differential for inheritance pattern, feeding Bayesian risk models, guiding testing decisions, and informing surveillance recommendations.

Pedigrees are the primary clinical document in clinical genetics, genetic counselling, cancer genetics, reproductive genetics, and rare disease diagnostic services. The chart must be interpretable by any trained reader without a key — because it will be read by colleagues across years and institutions.

What a genogram is

A genogram is a family-systems diagram popularised by Monica McGoldrick and Randy Gerson in their 1985 book Genograms in Family Assessment (now in its fourth edition as Genograms: Assessment and Treatment). Like a pedigree, it shows biological relationships. Unlike a pedigree, it layers emotional relationships, household boundaries, significant life events, substance use history, cultural identities, and patterns of family functioning across generations.

Genograms originate from family systems theory (Murray Bowen and colleagues), which treats the family as an emotional unit whose patterns of relationship and triangulation propagate across generations. A genogram is the visual tool for surfacing those patterns for clinical use in therapy, counselling, and allied social work.

Side-by-side: what each emphasises

Dimension	Pedigree	Genogram
Primary audience	Clinical geneticists, genetic counsellors	Family therapists, social workers, psychologists
Notation standard	NSGC (Bennett et al. 1995/2008/2022)	McGoldrick & Gerson conventions
Biological structure	Central focus	Present but not primary
Emotional relationships	Not represented	Central focus (close bonds, conflict, cut-off, triangulation)
Affected status / disease	Filled shapes with ICD-10/OMIM codes	Noted textually (mental health, addiction, chronic disease)
Inheritance analysis	Primary purpose	Rarely relevant
Risk models	BRCAPRO, MMRpro, Tyrer-Cuzick, BOADICEA	Not applicable
Household boundaries	Not typically shown	Often shown (dashed box around co-residents)
Cultural / ethnic annotation	Optional (ancestry)	Often central
Interoperability formats	GEDCOM 5.5.1, FHIR FamilyMemberHistory, HL7	Proprietary tool-specific formats
Typical software	Evagene, Phenotips, Progeny, TrakGene, FamGenix	GenoPro, GenogramAI, SmartDraw genogram templates

Relationship symbols: where they diverge

The core family structure — who is related to whom — uses the same symbols in both diagrams. Squares, circles, horizontal mating lines, vertical descent lines, horizontal sibship lines. The divergence starts with what is layered on top.

Genogram-specific emotional-relationship symbols (these do not appear in clinical pedigrees):

  Close relationship       Conflicted relationship    Cut-off
     ═══════                  ∿∿∿∿∿∿∿                 ─ ─ ─ ─
     (thick or               (jagged line)           (dashed or
      double line)                                    interrupted)

  Fused / enmeshed           Distant                   Abusive
     ══════════             ─ ─ ─ ─ ─                 ⟩⟩⟩⟩⟩⟩⟩
     (triple or             (thin or broken)         (jagged with
      very thick)                                     arrowheads)

Genograms also add symbols or colour codes for addictions (alcohol, drug, gambling), mental health (depression, bipolar, anxiety, suicide), abuse history, significant life events (immigration, loss, major trauma), and cultural identities (ethnicity, religion, language). These are clinically meaningful for a family therapist but have no place in a risk-model calculation.

When to use which

The decision usually follows the professional context and the clinical question.

Use a pedigree when:

You are assessing inherited-disease risk (cancer predisposition, rare disease, reproductive risk).
You need to run Bayesian risk models (BRCAPRO, MMRpro, PancPRO, Tyrer-Cuzick, BOADICEA) on the family data.
The chart will feed clinical testing decisions, surveillance, or pre-test counselling.
Records need to be shared across institutions using standard formats (GEDCOM, FHIR).
Your service is clinical genetics, cancer genetics, reproductive genetics, or rare disease diagnostics.

Use a genogram when:

You are working in family therapy, couples counselling, or marriage and family therapy.
The clinical question involves intergenerational patterns of relationship, addiction, or mental health.
You are documenting a family for social work, child protection, or family medicine.
Cultural context, household composition, or significant life events matter to the care plan.
You are teaching family systems theory or Bowen theory.

Either may apply in family medicine / primary care, where some physicians use a medical genogram (see below) to capture a longitudinal family history that includes both biological and psychosocial dimensions.

The medical genogram: a hybrid

A medical genogram is a family-medicine-oriented variant that keeps the genogram's breadth of family context but focuses on medical rather than therapy-specific information. Typical medical genograms record: chronic diseases (diabetes, cardiovascular, cancer), mental health history, substance use, cause of death, age at onset for major conditions, and sometimes key social determinants (living situation, main caregiver).

The medical genogram sits between a clinical pedigree and a family-therapy genogram. It does not typically feed Bayesian risk models, but it is useful to the family physician building a longitudinal picture of a patient and their household. Several EHR-integrated tools support a version of this — for example, GenoPro's Medical History Panel adds medical history fields to genogram individuals; some EHR vendors include simplified family-history modules that sit closer to the medical-genogram end of the spectrum than to the clinical-pedigree end.

Tools for each

Genogram tools (family therapy and social work):

GenoPro. The long-standing genogram product; supports emotional relationships, cultural annotation, and a medical history panel. Desktop-based.
GenogramAI. AI-assisted genogram generation from text narratives, aimed at therapists.
SmartDraw, Lucidchart, Canva. General diagramming tools with genogram templates, suitable for quick genograms.
Paper and pencil. Still widely used in training and in session with clients.

Clinical pedigree tools:

Evagene. Browser-based clinical pedigree with gesture drawing, 200+ disease catalogue, integrated BayesMendel risk models, AI interpretation, API and embed. See our clinical genetics pedigree tool guide.
Phenotips. HPO-driven genomic health record with pedigree module. See Phenotips vs Evagene.
Progeny, TrakGene, FamGenix, CanRisk. Established clinical genetics options, each with different strengths — reviewed on our compare page.
Madeline 2.0, QuickPed. Research pedigree tools.

Where Evagene sits

Evagene is unambiguously a clinical pedigree tool — NSGC notation enforced, BRCAPRO/MMRpro/PancPRO risk models built in, GEDCOM import and export, clinical reporting. That said, some Evagene features cross into the medical-genogram territory without turning the product into a therapy genogram:

A 55+ allergies catalogue — documenting drug, food, and environmental allergies alongside the pedigree, useful in family medicine and paediatric contexts.
A 50+ trait catalogue — non-disease heritable traits (eye colour, hair colour, handedness, lactose tolerance, taste perception) that a medical genogram or teaching pedigree may want to include.
Ancestry annotation — each individual can be tagged with one or more ancestries drawn from a controlled vocabulary, supporting ancestry-aware risk-model inputs and documentation.

Evagene does not implement family-therapy emotional-relationship symbols, household boundaries, or genogram-style substance-use / abuse annotations. For a therapy genogram those features matter and Evagene is not the right tool; GenoPro or GenogramAI is a better fit. For a clinical pedigree with some medical-genogram breadth, Evagene covers both the core NSGC requirements and the adjacent annotations many family physicians and paediatricians want.

How Evagene supports this

Within its clinical remit, Evagene captures more than the minimum a pedigree strictly requires. The disease catalogue (200+ ICD-10 / OMIM coded conditions) lets a clinician record multiple co-occurring conditions in the same family without abandoning structured data. The allergies and traits catalogues add family-medicine-relevant annotations. Ancestry tagging supports the population-specific elements of risk assessment (founder variants, population carrier frequencies) that matter in cancer genetics and reproductive genetics.

For services that want to share a pedigree with a family physician or paediatrician for routine record-keeping, Evagene exports as PDF (for the clinical record), PNG (for letters), SVG (for embedded portal views), or GEDCOM (for cross-system transfer). For services where the clinical question requires emotional-relationship or therapy-context analysis, a dedicated genogram tool is the correct choice — Evagene will not replace it and does not try to.

Our medical genogram software guide goes into more detail on the medical-genogram end of the spectrum, and our AI genogram tools overview covers the emerging AI-assisted genogram category.

Frequently asked questions

What is the difference between a genogram and a pedigree?

Pedigrees use NSGC-standardised clinical genetics notation centred on biological relationships and heritable conditions. Genograms layer emotional relationships, psychosocial context, and cultural information on top of family structure for therapy and social work use.

Can you use a genogram in a clinical genetics setting?

Not typically. Clinical genetics uses NSGC-standard pedigrees because risk models and interoperability depend on that notation. Family medicine sometimes uses a medical-genogram hybrid.

Who uses genograms?

Family therapists, marriage and family counsellors, social workers, psychologists, and some family physicians.

Who uses pedigrees?

Clinical geneticists, genetic counsellors, cancer genetics services, reproductive genetics, rare disease diagnostics, and researchers. Also used in biology teaching.

Can one piece of software do both?

Some tools straddle the two; no mainstream product does both categories at full depth. Choose based on the dominant use case.

What is a medical genogram?

A family-medicine variant that records chronic conditions, mental health, substance use, and cause of death alongside family structure. Sits between a pedigree and a therapy genogram.

Do genograms use the same symbols as pedigrees?

Core shapes and relationship lines are shared; genograms extend with emotional-relationship symbols and psychosocial annotations that do not appear in clinical NSGC pedigrees.

Genogram vs pedigree: two related but distinct family diagrams