Mental Health Genogram
Track psychiatric diagnoses, treatment history, and psychological patterns across generations. Map the family context of mental health for better assessment and treatment planning.
What Is a Mental Health Genogram?
A mental health genogram is a clinical tool that maps psychiatric conditions, psychological patterns, and treatment history across multiple generations. While the standard genogram developed by McGoldrick and Gerson includes space for medical and emotional information, the mental health genogram specifically prioritizes psychological and psychiatric data, creating a detailed picture of how mental health conditions cluster, manifest, and are addressed within a family system.
This tool is distinct from a medical genogram (which focuses on physical health) and from a trauma genogram (which focuses on traumatic events and their transmission). The mental health genogram specifically asks: What psychiatric conditions have appeared in this family? How severe were they? What treatments were tried? How did conditions affect functioning? And what patterns emerge across generations?
Clinical Significance
The heritability of psychiatric conditions is well-established: schizophrenia (80%), bipolar disorder (75-85%), ADHD (74%), major depression (40-50%), generalized anxiety (30-40%), and alcohol use disorder (50-60%). A thorough mental health genogram can reveal genetic loading that informs diagnosis, medication selection, and risk assessment. The landmark STAR*D trial found that family medication history is one of the strongest predictors of individual treatment response, making the genogram a practical prescribing tool.
When to Use a Mental Health Genogram
Clinical situations where mapping psychiatric family history improves care
Psychiatric Intake Assessment
The mental health genogram provides the most thorough family psychiatric history, going beyond a simple checklist to reveal patterns, severity gradients, and treatment responses across generations.
Medication Management
Family medication responses often predict individual responses. A genogram showing that three family members responded well to SSRIs guides initial medication selection. Conversely, a family history of bipolar disorder may contraindicate certain antidepressants.
Genetic Counseling
When clients are planning families and concerned about genetic risk for psychiatric conditions, the genogram provides a visual risk assessment showing distribution and severity across generations.
Treatment Planning
Understanding the family's relationship with mental health treatment (who sought help, who refused, what worked) informs realistic treatment planning and anticipates barriers to engagement.
Differentiating Genetic vs. Environmental
The genogram helps distinguish genetic vulnerability from environmental factors by examining which family members developed conditions and under what circumstances.
Psychoeducation
Showing clients their family mental health genogram normalizes their experience, reduces self-blame, and motivates engagement with treatment as a proactive step.
Key Elements to Map
Psychiatric-specific information to document for each family member
Psychiatric Diagnoses
Documented diagnoses for each family member: major depressive disorder, generalized anxiety, bipolar I/II, schizophrenia/schizoaffective, ADHD, OCD, PTSD, eating disorders, personality disorders.
Undiagnosed Behavioral Patterns
Behavioral descriptions suggesting undiagnosed conditions in older generations: prolonged sadness, extreme mood swings, paranoia, obsessive behaviors, attention difficulties, social withdrawal.
Hospitalizations
Psychiatric hospitalizations, emergency room visits for mental health crises, involuntary holds, and residential treatment stays. Frequency and duration indicate severity.
Medication History
What medications family members tried, what worked, what had adverse effects. This is clinically valuable for predicting the client's pharmacological response.
Suicide Attempts and Completions
Sensitively documented suicidal behavior: attempts, completions, and suicidal ideation across the family. Family suicide history is a significant risk factor.
Substance Use History
Alcohol, drug, and other substance use across generations. Note patterns of self-medication (drinking to manage anxiety), dual diagnoses, and recovery trajectories.
Treatment Engagement
Who sought therapy and for how long? Who refused treatment? What was the family attitude toward mental health care? This predicts the client's engagement and potential barriers.
Functional Impact
How mental health conditions affected daily functioning: work disability, relationship failures, parenting difficulties, social isolation, legal problems, or homelessness.
Clinical Example: The Patel Family
Fictional composite case for educational purposes
Presenting client: Priya (32) was referred by her primary care physician for "treatment-resistant depression." She had tried two SSRIs with minimal response and was feeling hopeless about treatment.
Generation 1 (Grandparents): Paternal grandfather had periods of extreme energy followed by months in bed (never diagnosed, but the description suggests bipolar disorder). He was known for impulsive business ventures that alternated with periods of withdrawal. Maternal grandmother experienced severe postpartum depression with each pregnancy but never sought treatment.
Generation 2 (Parents): Priya's father was diagnosed with bipolar II disorder at age 45 after years of being treated for depression alone. He responded well to a mood stabilizer (lithium) after years of poor response to antidepressants. Her mother experienced recurrent major depression, responding well to the SSRI sertraline.
Generation 3: Priya's brother was diagnosed with ADHD and bipolar disorder in college. He was currently stable on lamotrigine and stimulant medication.
Clinical impact: The mental health genogram immediately raised the possibility that Priya's "treatment-resistant depression" was actually undiagnosed bipolar II disorder, following the same pattern as her father: depressive episodes that responded poorly to antidepressants alone. Her father's positive response to lithium guided medication selection. After proper diagnosis and a mood stabilizer trial, Priya achieved remission for the first time in years. Without the genogram, the bipolar pattern might have been missed for years longer.
How to Create a Mental Health Genogram with GenogramAI
Map Family Structure and Psychiatric History
Describe your family to GenogramAI, including known diagnoses and behavioral patterns suggesting undiagnosed conditions. The AI generates the family structure while you add psychiatric annotations. Use the Medical View to attach diagnoses to each person.
Add Treatment and Medication Data
For each family member with mental health conditions, note what treatments were tried, what medications worked or failed, and what side effects occurred. This pharmacological family history is one of the most clinically actionable parts of the genogram.
Identify Patterns and Inform Treatment
Review the completed genogram for diagnostic patterns (mood disorders clustering on one side, anxiety on another), treatment response patterns (which medications worked across the family), and functional impact. Use these findings to guide current assessment and treatment planning.
Frequently Asked Questions
What is a mental health genogram?
A mental health genogram is a specialized family diagram that maps psychiatric diagnoses, mental health patterns, treatment history, and psychological functioning across at least three generations. Unlike a medical genogram focused on physical health conditions, the mental health genogram specifically tracks disorders like depression, anxiety, bipolar disorder, schizophrenia, ADHD, personality disorders, and substance use, along with hospitalizations, medication history, and therapy engagement.
How is a mental health genogram different from a medical genogram?
While both track family health patterns, a medical genogram focuses on physical conditions (heart disease, cancer, diabetes), and a mental health genogram focuses on psychiatric and psychological conditions. In practice, there is overlap, as conditions like chronic pain, autoimmune disorders, and neurological conditions may appear on both. Some clinicians create a combined genogram, while others keep them separate for clarity.
Why is family psychiatric history important?
Family psychiatric history is critical for several reasons: many mental health conditions have genetic components (heritability ranges from 40% for depression to 80% for schizophrenia and bipolar disorder), family patterns inform medication selection (a parent's response to a medication often predicts a child's response), and understanding family context helps differentiate genetic vulnerability from environmental transmission.
What if family members were never formally diagnosed?
This is extremely common, especially in older generations where mental health was stigmatized. Clinicians use behavioral descriptions instead: "Grandpa stayed in his room for months at a time" (possible depression), "Aunt Marie washed her hands until they bled" (possible OCD), "Uncle Paul had wild spending sprees then couldn't get out of bed" (possible bipolar). These descriptions are noted on the genogram as suspected or undiagnosed.
How do you handle stigma when creating a mental health genogram?
Mental health stigma is the biggest barrier to accurate family history. Normalize the process by explaining that mental health conditions are medical conditions with biological components. Use non-judgmental language, validate that previous generations had fewer resources, and frame the genogram as a tool for understanding and prevention, not blame. Some families are more comfortable with behavioral descriptions than diagnostic labels.
Can GenogramAI create mental health genograms?
Yes. GenogramAI includes a Medical View mode where you can add health conditions, including psychiatric diagnoses, for each family member. You can describe mental health patterns to the AI in natural language, and it will help organize the information into a visual genogram. The tool supports notes for treatment history, medication responses, and clinical observations.
Create a Mental Health Genogram
Map psychiatric family patterns with GenogramAI's Medical View mode. Build a comprehensive mental health family history in minutes.
Try GenogramAI Free