Alice: Madness Returns has been rated for the US and Canada as Mature.
The ratings board was quick to note the game’s gore, violence and foul language.
The full description reads:
This is an action-adventure game in which players assume the role of Alice Little, an asylum patient attempting to understand her past while struggling with an unbalanced psyche. As they traverse between the real world and Alice’s imagination (i.e., Wonderland), players use pepper grinders, knives, and other weapons to attack fantastical enemies (e.g., trolls, puppets, living teapots, doll-like creatures) in melee-style combat. Battles are accompanied by cries of pain, slashing sounds, and large splashes of blood that stain Alice’s body and the ground.
Some enemies can be decapitated, and certain attacks cause them to explode into pieces; in one sequence, young doll-like characters are depicted with bloody wounds that expose their brains. During the course of the game, the dialogue contains occasional references to prostitution (e.g., ‘I saw you down at the bloody whore house,’ ‘Where’d she be without me? On the streets selling her backside,’ and ‘Where’s me money?’/’Get those fat-a*s whores out on the street . . .’). The words ‘f**k’ and ‘c*nt’ can be heard in dialogue.
Thanks to CVG for the info.