- Rated R for strong violence and language throughout, some sexual content, drug use and for brief graphic nudity
- Niko's past is discussed at length throughout the game's plot, particularly him being involved in an eastern European war and two traitors giving his troop up for money. On some occasions he describes the events of the war, saying he "watched my friends die", and saw "a line of fifty children with their throats slit and their hands chopped off", and that "it ruined me".
- The dramatic nature of the game, although layered with comical elements, may unsettle some players. The story's depth is surprising and emotional.
- Many viewers may consider the violence, anti-law, sexual content, drug use and language to be offensive.
- BBFC - (18): very strong language, strong sex, violence, hard drug use.
- Toward the end, Niko finally encounters the traitor that gave up his war troop for money, Darko Brevic. Darko is seen drugged, insane, and emotionally unstable, and he begs Niko to kill him. The player is given the option to kill Darko or let him go free. Either case involves an emotional aftermath.
- At the end, either Roman or Kate is killed in a drive-by shooting. Both scenarios are emotionally upsetting in their own right.
- Roman's apartment and cab building are burned down in arson attacks. He cries and screams angrily, and explains that he left a ring in the apartment with which he planned to propose to Mallorie.