The Entertainment Software Rating Board (ESRB), the content rating board for games released in North America, has issued an "Adults Only" (AO) rating for 24 released video games. AO is the highest rating in the ESRB system, and indicates that the organization believes that the game's content is suitable only for players aged 18 years and over.
The majority of AO-rated games are adult video games, typically those with pornographic or strong sexual content. Four games have been given the rating solely due to extreme levels of violence: the canceled Thrill Kill (1998), the initial cuts of The Punisher (2005), Manhunt 2 (2007), and Hatred (2015). The only game to receive the rating for reasons other than pornographic content or extreme violence is Peak Entertainment Casinos (2003), which allows players to gamble using real money. Grand Theft Auto: San Andreas (2004) was temporarily re-rated from M ("Mature") to AO after a sexually-explicit minigame was found hidden in the game, but the M rating was reinstated after Rockstar Games patched out the content.
Self-imposed restrictions by publishers, distributors, and retailers limit the availability of AO-rated games, thus the rating has been described by journalists as a "kiss of death" and de facto ban.[1][2][3] All three major video game console manufacturers (Nintendo,[1][4] Microsoft,[5] and Sony[6][7]) prohibit AO-rated games from being published on their platforms. In May 2015, the video game livestreaming service Twitch updated its content guidelines to include a blanket ban on streaming AO-rated games, citing that a previous policy on games containing overt sexual content or extreme violence (which assessed games on a case-by-case basis) was unclear and confusing to broadcasters.[8]
In some cases, a game that initially received an AO rating from the ESRB was edited prior to their initial release in order to meet the criteria for an M rating. In selected cases, an AO-rated game was cancelled prior to its release, temporarily received the rating post-release due to the inclusion of normally-inaccessible content that met the rating, the uncut version of the game was released at a later date with an AO rating, or an unrated or self-rated version, patch, or downloadable content (DLC) was released via a platform with more liberal content rules (such as Steam).
PlayStation does not publish Adults Only games.
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