Appetitive Conditioning in Psychiatric Disorders: A Systematic Review

Appetitive conditioning—the process by which neutral cues acquire positive value through repeated pairing with rewards—is fundamental to adaptive behaviour. Disturbances in this process may contribute to psychiatric symptoms, yet unlike fear conditioning, it has been relatively underexplored in clinical populations. We systematically reviewed PubMed, Embase/MEDLINE, and PsycINFO (August 2025) for studies examining appetitive conditioning in psychiatric disorders. Of 7077 records, only five met inclusion criteria,: two on ADHD, two on compulsive sexual behaviour, and one on major depressive disorder. Patients demonstrated differences in reward-related neural and behavioural responses compared with controls, including reduced striatal activation during reward anticipation and heightened responses to reward receipt in ADHD, increased amygdala activation and disrupted striatal–prefrontal connectivity in compulsive sexual behaviour, and impaired probabilistic reward learning and decision-making in depression. None of the studies directly assessed de novo appetitive learning; instead, appetitive conditioning was employed as a preliminary paradigm to probe downstream reward processes. Thus, it remains unclear whether, or which, psychiatric disorders involve abnormalities in the formation of conditioned reward associations. Future controlled experiments that explicitly and directly test the learning processes associated with appetitive conditioning are needed to clarify its role in psychopathology and its potential as a target for intervention.