The Binding of Isaac: Repentance+

The Binding of Isaac: Repentance+ is rated M for Mature 17+ by the ESRB with Blood and Gore, Crude Humor, Language, Use of Drugs, and Violence. Also includes Users Interact. This is a 2D action-adventure game in which players help a child, Isaac, escape from being violently harmed by his mother. From a top-down perspective, players solve puzzles, traverse basement dungeons, and battle boss characters that represent Isaac's deepest fears and insecurities. Players use various weapons (e.g., teardrop projectiles, toxic flatulence, streams of blood) to kill enemies. Attacks are highlighted by blood-splatter effects, dismemberment, and decapitation; several dungeons are littered with blood pools and entrails. Some rooms depict large amounts of feces and urine on the floor; certain items allow players to defecate, urinate, or transform into excrement-themed characters. During the course of the game, players' character can consume a Wavy Cap mushroom, resulting in psychedelic imagery and screen-distortion effects; players' character can also use administer a Roid Rage syringe, giving them a status boost. One cutscene briefly shows a cloud character raising its middle finger (i.e., flipping the bird).