The ESRB was established in 1994 by the Entertainment Software Association (ESA, formerly the Interactive Digital Software Association (IDSA)), in response to criticism of controversial video games with excessively violent or sexual content, particularly after the 1993 congressional hearings following the releases of Mortal Kombat and Night Trap for home consoles and Doom for home computers.

Although its graphics were relatively primitive, the game's overall theme and the sound effects made when gremlins were killed were considered disturbing by players, prompting media attention.

[2][3] A 1983 industry crash, caused by the market being overrun with low-quality products, prompted a higher degree of regulation by future console manufacturers: when the Nintendo Entertainment System (NES) was launched in the United States in 1985, Nintendo of America instituted requirements and restrictions on third-party developers, including the requirement for all games to be licensed by the company.

Two games of this era were specifically cited in the hearings for their content; the fighting game Mortal Kombat featured realistic, digitized sprites of live-action actors, blood, and the ability to use violent "fatality" moves to defeat opponents, while Night Trap featured 90 minutes of FMV content, with scenes that were considered to be sexually suggestive and exploitive.

[4][8] In May 1993, British censors banned Night Trap from being sold to children under 15 years old in the United Kingdom, which was an influence on Sega's decision to create an age rating system.

However, Lieberman did not believe that these systems were sufficient, and in February 1994, threatened to propose the creation of a federal commission for regulating and rating video games.

[13] With the threat of federal regulations, a group of major video game developers and publishers, including Acclaim Entertainment and Electronic Arts along with Nintendo and Sega, formed a political trade group known as the Interactive Digital Software Association in April 1994, with a goal to create a self-regulatory framework for assessing and rating video games.

[24] In response to the growth of smartphone use, in November 2011, CTIA, a group of major U.S. companies representing the wireless industry, and ESRB announced the co-development of a free, voluntary ratings process for mobile app stores.

Verizon Wireless and T-Mobile US were among the first to implement the system for their own application storefronts, and Microsoft's Windows Phone Marketplace already supported ESRB ratings upon its introduction.

[29][30] The three major console makers, Microsoft, Sony, and Nintendo have all committed to supporting IARC for their digital storefronts, including ESRB ratings for North American markets.

Most ESRB reviews at this stage take on the order of 45 minutes, though some cases based on material provided by publisher or by the type of game have taken up to four hours over multiple days to complete.

To lessen their impact, the developer changed these scenes to be rendered in black and white: the revised cut of the game was re-submitted, and received the M rating.

[10] Penalties apply to publishers who misrepresent the content of their games, including the potential for fines up to US $1 million and a product recall to reprint proper labels, if deemed necessary.

[26][32][42] The ESRB phased out the Short Form for digital-only games, instead directing those developers and publishers to use the similar free questionnaire-driven IARC program, which was being adopted beyond mobile app stores, including the Nintendo eShop and PlayStation Store, as a requirement for posting, and which automatically are accepted by several national-level rating boards, including the ESRB.

[43] In response to concerns from Sony on the growing number of indie game titles that were receiving physical releases alongside retail ones, the ESRB began instituting new rules around August 2017 that any retail product was mandated to undergo the standard Long Form review for the game, disallowing the use of the Short Form for such titles.

Alongside this, ESRB introduced a "value tier" for the Long Form review process for games developed at lower budgets (under $1 million), with a cost of $3000 for obtaining the retail rating.

The changes were intended to increase the icons' clarity at smaller sizes (such as on mobile devices), reflecting the growth in the digital distribution of video games.

There have been isolated cases of games receiving the rating for other reasons, including high-impact violence, and allowing players to gamble using real money.

[66][31][67][68][69] However, in March 2019, it was revealed that there are still undisclosed limitations to this policy based on "costs and risks" associated with Steam's ability to distribute specific games.

In 2004, California Assemblyman Leland Yee sponsored a state bill requiring retailers to stock M-rated games on separate shelves that are at least 5 feet (60 in) from the ground.

The term was defined using a variation of the Miller test (originally created to judge whether a work is obscene), separate from any rating the game may have received.

In June 2013, the service was extended to mobile apps, with a particular emphasis on helping application developers comply with the then-upcoming changes to the Children's Online Privacy Protection Act.

[88] By 2008, the Federal Trade Commission reported 20% of underaged mystery shoppers were able to successfully purchase an M-rated video game from a selection of retailers—a 22 percent reduction from 2007.

[89] In its 2009 Report to Congress, the FTC recognized the ESRB for having "the strongest self-regulatory code" of all entertainment sectors because of its enforcement of advertising and marketing guidelines.

[95][96] In 2005, the National Institute on Media and the Family (NIMF) criticized the ESRB for seldom-using the Adults Only rating, arguing that because it has a vested interest in the video game industry, it did not want to perform actions that would affect their commercial availability.

[103][104][105] In January 2015, Hatred, a controversial game whose plot centers around a character indiscriminately murdering everyone he encounters, received the rating for its extreme violence and harsh language; one of the game's developers disputed the rating, arguing that "its violence isn't really that bad and this harsh language isn't overused", but also acknowledged the rarity of their situation.

"[5] However, several U.S. politicians, including Senator Sam Brownback, California State Senator Leland Yee, and Michigan Congressman Fred Upton (who was a major critic against Rockstar during the controversy), still felt that the ESRB had "lost" its trust of consumers, believing that video game developers were taking advantage of the board's conflict of interest with the industry to incorporate objectionable content into their products without the ESRB's full knowledge.

[7][118][119] In October 2017, in response to growing criticism of the loot box model for video game microtransactions (which grant chances at earning randomized items of various rarities, typically cosmetic in nature, in exchange for payment), the ESRB stated their opinion that they were not a form of gambling.

[27][120] On February 14, 2018, U.S. senator Maggie Hassan asked the ESRB to examine if games with loot box microtransactions were being marketed in an "ethical and transparent way" that "adequately protects the developing minds of young children from predatory practices.

"[121] The ESRB subsequently announced on February 27, 2018, that it would introduce a new label for any games that contain "the ability to purchase digital goods or premiums with real world currency".