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It has been dubbed the 'sickest ever' video game because players only have one aim - to massacre as many people as possible in a 'genocide crusade'. 

Now, Killing-spree simulator, 'Hatred', has been given an adults only (AO) rating from ESRB, the video game ratings board in the US and Canada.

Such a high rating is rare in the gaming industry, with 'M for Mature' far more common, and the only other game to receive an AO rating for violence is 'Manhunt 2'. 

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Killing-spree simulator, 'Hatred', has been given an Adults Only (AO) rating from ESRB, the video game ratings board in the US and Canada. Hatred has been called the 'sickest ever' game and involves one man who wants to carry out a 'genocide crusade' because humans are 'worms and 'no life is worth saving'

Despite its violence, the developers of Hatred are surprised by its rating, which is equivalent to the NC-17 rating among movies.

'Well, I'm not quite convinced why Hatred got AO rating while it lacks any sexual content,' said one developer on their forum.

'It's still some kind of achievement to have the second game in history getting AO rating for violence and harsh language only. 

'Even if this violence isn't really that bad and this harsh language isn't overused.'

'Hatred' is the story of a lone wolf gunman who 'hates the world' and acts out his fantasy of brutally murdering the public and police because 'no life is worth saving'.

Gamers are encouraged to murder everyone they see, including police officers (left) and the public (right)

Fans took to Twitter comment on the rating, which may have encouraged more young people to play the game

The hooded killer uses machine guns, knives and explosives to kill in the streets, in schools and public buildings because of his 'bitter hatred' of 'human worms'.

MANHUNT 2: THE ONLY OTHER GAME EQUAL TO 'HATRED' IN VIOLENCE 

In the game, Manhunt 2, players take the role of a patient who has escaped from an asylum

The only other game to receive an AO rating for violence is 'Manhunt 2'.

In the game, players take the role of a patient who has escaped from an asylum after an experiment at a secret research facility goes wrong.

Players can perform 'executions' either hasty, violent or gruesome on 'enemies' such as the police and armed forces employed by the project.

It was developed by Rockstar London for Microsoft Windows and PlayStation 2, Rockstar Leeds for the PlayStation Portable, and Rockstar Toronto for the Wii.

After its release he ESRB felt that Manhunt 2 was so violent that it took the extraordinary step of giving a game an AO rating for violent content

The title, which has been developed by Polish company Destructive Creations, was initially banned from marketplace Steam - but later reinstated after complaints from gamers.

Footage from its trailer shows the main character killing indiscriminately with a number of different weapons - and it ends with the line 'death is coming in 2015'.

The character says as he prepares to start the massacre: 'I just hate this world and the human worms feasting on its carcass. 

'My whole life is just cold, bitter hatred, and I always wanted to die violently. This the time for vengeance and no life is worth saving - and I will put in a grave as many as I can.

'It's time for me to kill and time for me to die. My genocide crusade'.

The description of the game reads: 'Hatred fills your whole body. You're sick and tired of humanity's worthless existence.

'The only thing that matters is your gun and pure Armageddon that you want to unleash.

'You will go out for a hunt, you will clear the American soil of humans with cold blood.

'You will shoot, you will hurt, you will kill, you will die.

'There are no rules, no compassion, no mercy, no point of going back. You are the lord of life and death now and you have the full control over life's of worthless human scum.

'You will also run, you will need to think, you will need to hide and fight back when armoured forces will come to take you down.

'You will have no mercy for them, because they dare to come in your way.

'Only brutality and destruction can clear this land. Only the killing spree will make you die spectacularly and go to hell.'

Hatred: Is this the most sickening computer game ever?

Horrifying: In one scene in the trailer the gunman opens fire in a public library killing everyone inside

The initial trailer for the horrifying game shows the unnamed protagonist strolling around a city with a machine gun, performing a series of gruesome executions on innocent civilians.

At one point, an Asian lady screams for mercy just before she is shot in the head at point blank range, while another slaying sees a police officer have his head blown off with a shotgun.

The game was initially banned by Steam, because the violence was too graphic and unjustified, but not before it had received a horrifying 14,000 'likes.'

Steam is a digital game shop for platforms including Windows, Mac and Linux.

But in December, Steam boss Gabe Newell reinstated the controversial game, and it has since gathered an additional 27,000 'likes'.

Developer Destructive Creations said: 'This is the best proof for us that there are diehard Hatred fans out there, waiting for this game to be released.

'And that we need to keep going to deliver them a game that offers exciting and challenging gameplay.

'The whole situation only pushes us forward to go against any adversity and not to give up.

'It also makes us want to provide our fans Hatred pre-orders sooner, as many of you have asked for them.

'At the end of the day you, gamers will judge if we were able to do a game that's simply fun to play.'

Thousands of gamers have already commented on Hatred, slamming the graphic portrayal of violence.

Grim: It also shows the aftermath of one of the killing sprees with bodies strewn every where

Response: But other gamers say that it should be banned calling it 'wrong' and 'distasteful'

They say that controversial games like Grand Theft Auto do allow people to kill, but players can also choose to do other things.

One said: 'This is the sickest game ever. It's basically spree-killing - like Columbine, Virginia Tech, Sandy Hook and Dunblane.

'Whoever wants to play this needs their head examined.'

Youtuber 'O Canal BP' wrote: 'This is wrong. Yes I run over and shoot people on Grand Theft Auto, but that's optional.

'This is not optional - you have got to kill a bunch of innocent people because the main character is on a suicide mission.'

Another gamer added: 'The fact that anyone would want this monstrosity to exist is astounding to me.

'The fact that a few thousand people said yes to it is mind-numbing.

'What kind of sick people live in this world, who would make and enjoy a game about violently murdering civilians?'

Player 'Tapport' said: 'In my opinion this game is really distasteful and serves no propose to gaming but at the same time I think people should be able to play what they want.

'I can guarantee one thing though, next mass shooting in the US by someone who has ever touched a video game is getting blamed on this game. Probably even someone who hasn't.'

Yet many others support the game, including player MuscularYoda, who wrote: 'This game does not go far enough.'