Genogram Symbols: A Complete Visual Guide for Practitioners

Genogram symbols are standardized notations used to visually represent family structure, relationships, and health patterns across generations. The family diagram was originated by Murray Bowen, and the standardized symbol set was developed by Monica McGoldrick and Randy Gerson (first published in 1985 and refined in later editions). They are commonly grouped into the following categories:

1. Structural symbols — squares for men, circles for women, with markers for deceased, pregnancy, miscarriage and unknown sex
2. Relationship lines — horizontal lines connecting partners (married, divorced, separated) and vertical lines connecting parents to children
3. Emotional relationships — patterned lines showing closeness, conflict, distance, estrangement and fusion (the published standard is monochrome; color is a software convention)
4. Health and social conditions — shading and patterns indicating medical, psychiatric or substance-use conditions
5. Specialized symbols — adoptions, twins, IVF, foster care and cultural or spiritual indicators
6. Annotations — birth and death dates, names, and clinically relevant life events

Looking for a quick reference? See our Genogram Symbols Reference Chart for a table-based overview of all symbols, or continue reading for in-depth explanations with clinical context.
📄 Download the free PDF Cheat Sheet — print-friendly, one page.
🧩 Want to use these symbols right away? Try our free genogram maker — every symbol is built in.

Murray Bowen developed the family diagram in the 1960s and 1970s as part of Bowen family systems theory. Monica McGoldrick and Randy Gerson later formalized the standardized genogram symbols that practitioners use today (McGoldrick & Gerson, 1985), a set further codified in subsequent editions (McGoldrick, Gerson & Petry, 2008, 2020). The symbols fall into three broad groups: structural symbols depicting family members, line symbols representing relationships, and shading or graphic symbols indicating health conditions and life circumstances.

Structural Symbols: Representing Family Members

The most fundamental genogram symbols represent individual family members. These symbols convey basic demographic information at a glance.

Gender Symbols

The core gender symbols have remained consistent since Bowen's original system:

• Square: Male
• Circle: Female
• Question mark (?): Sex unknown or unspecified (placed in or beside the symbol)
• Diamond: Not a marker for unknown sex. In the most widely used conventions a diamond denotes a pet, while McGoldrick's 4th edition (2020) uses it for a non-binary or gender-diverse person. Always check the genogram's key.

Age and Status Indicators

Additional information can be incorporated into or around these basic shapes:

• Age: Written inside the symbol or below it
• Name: Written below or beside the symbol
• Deceased: An "X" through the symbol, with death date noted
• Identified patient/client: Double border around the symbol
• Pregnancy: A triangle placed on the child line beneath the parents
• Miscarriage / spontaneous abortion: A small triangle with an "X" through it
• Induced (elective) abortion: As miscarriage, with an added horizontal line
• Stillbirth: The gender symbol (square or circle), drawn smaller, with an "X"; "SB" may be added as a label

Birth Order and Placement

According to standard conventions, children are arranged from left to right in order of birth, with the oldest on the left (McGoldrick, Gerson & Petry, 2008). Butler (2008) notes that in Bowen's original family diagram format, males were placed on the left and females on the right of couple pairings.

Relationship Lines: Mapping Family Connections

Relationship lines connect individual symbols to show how family members relate to one another. These lines represent both legal/biological relationships and emotional patterns.

Couple Relationships

Horizontal lines connect partners and indicate their relationship status:

• Marriage: Single solid horizontal line, usually with the marriage date (m. YYYY)
• Cohabitation/Living together: Dashed horizontal line (McGoldrick standard). Butler (2008) notes that Bowen's earlier family-diagram tradition instead used a solid line marked "LT"
• Engagement: Dashed or dotted line with notation
• Separation: Single line with one diagonal slash
• Divorce: Single line with two diagonal slashes
• Multiple marriages: Shown side by side, with the earliest marriage toward the outer edge and the current spouse placed closest to the index person

Parent-Child Connections

Vertical lines connect parents to children:

• Biological child: Solid vertical line from the couple line to the child
• Adopted child: Dashed vertical line (the standard); some practitioners add brackets or an "A"
• Foster child: Dotted vertical line, often with an "F" notation
• Twins: Two vertical lines converging to a single point on the couple line
• Identical twins: Twins connected by a horizontal bar

Emotional Relationship Patterns

Beyond structural connections, genograms can depict the quality and nature of relationships between family members. McGoldrick and colleagues developed the extensive system of emotional-relationship lines that is widely treated as the standard reference for genogram practice. In the published standard these lines are monochrome and distinguished by pattern (not color); the color schemes seen in many software tools, WebGeno included, are added for on-screen readability.

Common Relationship Patterns

• Close: Two parallel lines
• Fused / Enmeshed: Three parallel lines — signifying a loss of boundaries, not simply healthy closeness
• Distant: Single dashed line
• Estranged / Cut off: Line with a break or perpendicular bars (a "fence")
• Conflictual: Jagged (zigzag) line. (A smooth wavy line is a separate symbol meaning a spiritual connection, not conflict.)
• Fused and conflictual: Three parallel lines overlaid with a jagged line
• Focused on: Arrow pointing toward the focus of attention
• Abusive: A jagged line ending in an arrow pointing at the abused person — a filled arrowhead denotes physical abuse, an open arrowhead emotional abuse, and a jagged line enclosed between two parallel lines sexual abuse

These relationship indicators help practitioners visualize emotional patterns that may span multiple generations, supporting assessment of what Bowen termed the "multigenerational transmission process" (Puskar & Nerone, 1996).

Health and Social Condition Symbols

One of the most clinically useful aspects of genograms is their capacity to track health conditions, mental health issues, and social circumstances across generations.

Standard Approaches from the Literature

The traditional method for representing health conditions involves shading or marking part of the individual's symbol, with a key explaining what each marking means:

• Lower-half shading: Substance or alcohol use — the most widely recognized condition convention
• Left-half (or other) shading: Physical or mental illness
• Fully shaded symbol: Indicates the person is affected by the charted condition
• Sectioned symbols: Some practitioners divide the symbol into sections, each keyed to a different condition or category

Health-condition notation is the least standardized part of genogram practice. Beyond the shading conventions above there is no single agreed icon for every disease, so practitioners and software tools adopt varying approaches and rely on a legend. (Note: shading a symbol to indicate carrier status belongs to medical-genetics pedigree charts, a related but distinct notation, not to standard genograms.)

Common Condition Categories

Regardless of the specific notation system used, practitioners commonly track:

• Cardiovascular conditions: Heart disease, hypertension, stroke
• Mental health: Depression, anxiety, bipolar disorder, schizophrenia
• Substance use: Alcohol abuse, drug addiction
• Cancer: Breast, colon, lung, and other malignancies
• Metabolic disorders: Diabetes, thyroid conditions
• Neurological conditions: Dementia, Parkinson's disease

Specialized Symbol Systems

As genogram practice has evolved, practitioners have developed specialized symbol sets for specific clinical contexts.

Variations by Theoretical Approach

Butler (2008) documents numerous specialized genogram types, each with adapted symbols:

• Cultural Genogram (Hardy & Laszloffy, 1995): Incorporates cultural identity markers
• Spiritual Genogram (Wiggins-Frame, 2000): Religious affiliation and spiritual practices
• Sexual Genogram (Hof & Berman, 1986): Attitudes and patterns related to sexuality
• Time-line Genogram (Friedman et al., 1988): Temporal sequencing of events

Best Practices for Using Symbols

Consistency and Clarity

Whatever symbol system you use, consistency is essential. Because health-condition notation in particular is not fully standardized across the literature, clarity matters. To maintain it:

• Use a legend to define any symbols that might be ambiguous
• Follow established conventions (McGoldrick et al. remains the primary reference)
• Apply the same symbols consistently throughout a single genogram

Practical Considerations

• Keep it readable: Avoid overcrowding with too many symbols
• Use color strategically: Color can differentiate condition categories but ensure accessibility
• Date your genogram: Family situations change; dating helps track evolution
• Include a key: Especially important when sharing genograms across disciplines

How WebGeno Represents These Symbols

Everything above is the field standard. The notation in this section is specific to WebGeno and is offered as one practical, readable way to chart health conditions on screen; it is not a universal convention.

• Four inner quadrants: Cardiovascular (top-left), Mental/Neurological (top-right), Cancer (bottom-left), Metabolic/Endocrine (bottom-right)
• Outer ring: Additional categories including Respiratory, Autoimmune, Musculoskeletal, and Other conditions
• Distinct patterns: Each category uses a unique visual pattern (diagonal stripes, dots, crosshatch, horizontal lines, etc.) to aid quick identification
• Color: Added for on-screen readability; the published standard is monochrome and pattern-based

This WebGeno-specific implementation supports 47 pre-defined health conditions across 8 categories, with the ability to add custom conditions as needed. Because it builds on the standard idea of shading and sectioning a symbol, and always renders an explanatory legend, the genograms you create stay readable to practitioners who use the conventional notation.

See the quadrant system in action in this short demo:

Conclusion

Genogram symbols provide practitioners with a powerful visual vocabulary for documenting family patterns across generations. From basic structural symbols established by Bowen in the 1960s to contemporary additions for health conditions and relationship patterns, this system enables efficient communication of information that would otherwise require extensive narrative description.

Mastering these symbols allows practitioners to create genograms that serve multiple purposes: clinical assessment, treatment planning, client education, and professional communication. For practitioners new to genograms, beginning with the fundamental structural and relationship symbols provides a solid foundation. As familiarity grows, incorporating health condition tracking and specialized symbol systems can enhance the clinical utility of this essential assessment tool.

Ready to put these symbols into practice? Learn how to create a complete genogram from start to finish in our comprehensive step-by-step genogram tutorial, which walks you through the entire process of family assessment using these powerful visual tools.