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A few Parkinson patients develop a disabling pattern of compulsive dopaminergic drug use (“dopamine dysregulation syndrome”—DDS). DDS patients commonly identify aversive dysphoric “OFF” mood‐states as a primary motivation to compulsively use their drugs. We compared motoric, affective, non‐motor symptoms and incentive arousal after overnight medication withdrawal and after levodopa in DDS and control PD patients. Twenty DDS patients were matched to 20 control PD patients for age, gender, and disease duration and underwent a standard levodopa challenge. Somatic symptomatology, positive and negative affective states, drug effects, reward responsivity, motor disability, and dyskinesias were tested in the “OFF”‐state after overnight withdrawal of medications, and then after a challenge with a standard dose of levodopa, after a full “ON”‐state was achieved. In the “OFF”‐state, DDS patients …