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The following is a list of video games that have been given the "Adults Only" (AO) rating by the Entertainment Software Rating Board (ESRB), a United States-based organization which rates the content of video games to determine its appropriateness for specific age groups. Although it is not legally binding under U.S. law, the ESRB rating system is a de facto standard which is self-enforced by the U.S. video game and retail industries. In Canada, ESRB ratings are enforceable by provincial law by film classification boards in some provinces.
Games with the AO rating are considered by the board to be suitable for players age 18 and over; AO-rated games can contain higher levels of violent, profane, sexual, or pornographic content than the next-lowest rating on the scale, Mature (M), which is generally considered suitable for players 17 and over, can accommodate. AO is the highest and most restrictive of the ESRB's content ratings, and dramatically impacts the commercial availability of games which carry it; all three major video game console manufacturers (Nintendo, Microsoft, and Sony Interactive Entertainment) refuse to allow AO-rated games to be published for their platforms, most retailers refuse to stock AO-rated games, while the popular video game live streaming service Twitch explicitly bans all games carrying the rating. Due to these self-imposed restrictions on the marketing and distribution of games with the rating, the AO rating has been described as a "kiss of death" by critics.
Relatively few games carry the AO-rating; the majority of AO-rated games are adult video games which received the rating for containing sexual and/or pornographic content, but the ESRB has also issued the rating for games containing extreme violence. The fighting game Thrill Kill (1998) was given the AO rating for its violent content, but was left unreleased after its developer, Virgin Interactive, was acquired by Electronic Arts, who objected to the game's sexual overtone and violent content. Rockstar Games' Manhunt 2 (2007) was the second game given an AO rating for extremely violent content, but was re-edited to meet the M rating so it could be released on consoles (an uncut, AO-rated version for Windows was released in 2009).
Fellow Rockstar game Grand Theft Auto: San Andreas (2004) was temporarily re-rated to AO from M in response to the release of a mod known as "Hot Coffee", which restored access to an incomplete, but sexually explicit minigame that had been removed in development; later releases of the game were edited to expunge the incomplete minigame, and were rated M. Hatred (2015), a game centering on a character indiscriminately murdering everyone he encounters, was the third game to receive the rating solely for violence.