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. A fourth game, The Punisher (2005), was also given the AO rating solely due to excessive, brutal violence, but like Manhunt 2, was censored before its release to meet a Mature rating. Three games have been given the rating solely due to extreme levels of violence: the canceled Thrill Kill (1998), the initial cut of Manhunt 2 (2007), and Hatred (2015). The majority of AO-rated games are adult video games, typically those with pornographic or strong sexual content. AO is the highest rating in the ESRB system, and indicates the game's content is suitable only for players aged 18 years and over. The Entertainment Software Rating Board (ESRB), the video game content rating board for North America, has issued an " Adults Only" ( AO) rating for 26 released video games.
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