Violence in video games has always been a controversial topic. Games like Doom and Mortal Kombat have faced criticism for their graphic content, leading to strict age ratings similar to those of movies. But beyond the Mature rating, there's the elusive Adults Only (18+) category, reserved for extreme cases. It's important to note that major gaming platforms like Sony, Microsoft, and Nintendo do not allow Adults Only games on their systems, and their sale is heavily restricted.

Updated December 30, 2023 by Mark Sammut: As of 2018, there are no Adults Only games, and the last project to receive this rating was in 2018. With the AO rating being a barrier for console games, only PC releases can carry the ESRB label, and they don't require a rating to be accepted onto platforms like Steam.

Grand Theft Auto: San Andreas

The Infamous Hot Coffee

Grand Theft Auto: San Andreas garnered attention for its Hot Coffee minigame, leading to an Adults Only rating due to the inclusion of this removed content. Interestingly, the rating was later revised to Mature after Rockstar removed all traces of Hot Coffee from the game.

The Punisher

Graphic Death Scenes

The Punisher, originally carrying an AO rating, was later toned down to an M rating by presenting the violence in black and white, making it suitable for wider release.

Manhunt 2 (PC Edition)

Blood-Soaked Murder Spree

The notorious Manhunt 2 received an AO rating for its violent content, but the game was modified to meet the standards for an M rating, except for the uncut PC version, which retained the Adults Only rating.

Leisure Suit Larry: Magna Cum Laude Uncut And Uncensored

Larry's Wildest PC Adventure

The Leisure Suit Larry series released an AO version on PC, presenting the adult-themed game in its unfiltered form. This edition allowed players to experience the game with its original content.

Hatred

Mass Murder Sim

Hatred, resembling a murder simulator, was an intentionally controversial game aiming for an AO rating. It stood out among traditional games typically found on store shelves due to its extreme content.

Agony

An Unapologetically Nasty Trip Hell

Initially earning an AO rating, Agony was modified to receive an M rating for broader release. However, a later iteration titled Agony Unrated hinted at the original Adults Only content, although it's not currently available for purchase.

Thrill Kill

Vicious Fighter

Thrill Kill was one of the earliest games to receive an AO rating for its violent content, ultimately leading to the cancellation of its release. The game revolved around brutal fights among damned characters, and its extreme violence caused significant controversy.

Fahrenheit: Indigo Prophecy Director's Cut

An AO Version That Might Or Might Not Exist

Fahrenheit: Indigo Prophecy Director's Cut raised speculation about an AO version, although its existence in the wild remains a mystery. Quantic Dream's game, upon remastering, was based on the international release, presenting the uncensored content absent in the North American version.

Special Mention: Outlast 2

Outlast 2, a harrowing horror game, undertook preemptive measures to secure a Mature rating by removing certain content. However, these scenes were later reintroduced to the Steam version, indicating a less-restricted experience on the platform.