AO is the highest of the ESRBs content ratings, and restricts the commercial availability of games which carry it; all three major video game console manufacturers ( Nintendo, 5 Microsoft, 6 and Sony 7 ) refuse to allow AO-rated games to be published for their platforms, most retailers refuse to stock AO-rated games, and the popular video game live streaming service Twitch explicitly bans all games carrying the rating.

The only mainstream platform to allow AO-rated games is Steam, which hides them by default.

Relatively few games carry the AO-rating; the majority of AO-rated games are adult video games which received the rating for containing sexual andor pornographic content, but the ESRB has also issued the rating for games containing extreme violence.

The fighting game Thrill Kill (1998) was given an AO rating for its violent content; its release was cancelled after the acquisition of its publisher, Virgin Interactive, by Electronic Arts, as they objected to the games content.

Rockstar Games Manhunt 2 (2007) was the second game given an AO rating for extremely violent content and the first to be released, 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).

Hatred (2015), a game centering on a character indiscriminately murdering everyone he encounters, was the third game to receive the rating solely for violence and the second to be released.

The only game to receive the rating for reasons unrelated to violence or sexual content is Peak Entertainment Casinos (2003), 12 which received the rating as it allows the player to gamble using real money.

San Andreas remains the only mass-released AO game.

Its rating was changed back to M after Rockstar patched the game to remove the offending content entirely.

The only mass-released AO-rated game.

Ars Technica. Cond Nast.

Archived from the original on 2013-12-16.

Vancouver Sun. Postmedia Network.

Archived from the original on 18 March 2014.

Peter Moore on AO-rated games: You have to draw the line somewhere.

Sony, Nintendo refuse to allow AO rated games on their consoles.

GameSpot. CBS Interactive.

Archived from the original on 2011-07-22.

Archived from the original on 2013-12-13.

Siliconera. Curse, Inc.

Archived from the original on 2014-10-28.

The worst trailer of the year revels in slaughtering innocents.

Polygon. Vox Media.

Archived from the original on October 17, 2014.

Manhunt 2 Dated in UK.

GamesIndustry.biz.

Archived from the original on 2014-03-14.

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