Those top 10 most violent game lists are seriously misinformed.
This IS, without a doubt, the most violent game ever made. You can hold a knife and strip away pieces of a mans head. You can toss a grenade and their gibs will stick to the walls. You can bayonet someone until their brains show. You can blow arms off, legs off, heads off or just pieces of limbs off. You can empty two clips from dual uzi's into someone and they'll wriggle around on their feet as their body gets torn apart until you stop. You can set people on fire, you can cut off their hands, you can blow their intestines out.
EVERY top 10 most violent game list i've read has been SO frigging stupid. They list games like mortal kombat, gears of war, that while, yeah they ARE violent, are nothing compared to games like this. It really irritates me.