http://www.gamespot.com/articles/hatred-rated-adults-only-in-north-america/1100-6424713/

Hatred, the controversial massacre simulator, has received an Adults Only rating from the Entertainment Software Rating Board, the organization that rates games in North America.

"Well, I'm not quite convinced why Hatred got AO rating while it lacks any sexual content, but it's still some kind of achievement to have the second game in history getting AO rating for violence and harsh language only," a Destructive Creations developer said on the game's official forum. "Even if this violence isn't really that bad and this harsh language is not overused. The guy from ESRB (by the way - very nice, polite and cooperative one) told me it's all about 'the context' which people they're testing gameplay video on will see."

The Adults Only, or AO rating, is the harshest rating the ESRB has for content. It's rarely used, and is described by the ESRB as suitable for ages 18 and up for prolonged scenes of intense violence, graphic sexual content, and/or real money gambling. All three major console manufacturer—Sony, Microsoft, and Nintendo—have a policy that forbids publishing Adults Only-rated games on their platforms, so unless Destructive Creations changes to content in Hatred, we won't see it released on the Xbox One and PlayStation 4.

Hatred was pulled from Steam Greenlight recently and then reinstated a little more than a day later, following an intervention by Valve managing director Gabe Newell. However, Valve has never made Adults Only-rated games available for sale on Steam before.

"I would prefer to get a standard M+ rating, because with AO we will have problems to get to consoles in the future, but on the other hand I think you guys (our fans) would be disappointed with it," the Destructive Creations developer said.