Violence is simply just another form of artistic expression – one used to help in enriching or deepening the meaning behind something, or to something else connected with it, acting essentially as an epiphenomenon - and one which probably represents reality better than most. Some watch it purely for entertainment value, others through some sort of sadistic or artistic applicability. Of course it can also be used just to shock when no real or initial meaning can be found (Apocalypse Zero springs to mind).
I'm quite surprised to see that Urotsukidoji hasn't been listed here – Legend of the Overfiend and Legend of the Demon womb. It's easily one of the most infamous anime ever known, and has also frequently been deemed the sickest. When it was released some of its more explicit scenes were entirely removed in the US, the UK, and Australia by the BBFC and OFLC - where new animation had to be created for the sake of continuity. And in later chapters, such as The Secret Garden and The Long Road to God, the content was considered so perverse and explicit in nature they ended up being banned entirely throughout many contries.
So if you like, or are at least comfortable with the thought of women being raped and mutilated by huge demons and insane scientists; apocalypticism, misanthropy, mass slaughter, watching the world as it's destroyed, and seeing massive blood-thirsty monsters fighting to the death in battles of carnage and destruction, then Urotsukidoji is the anime for you! And if you do plan on watching it, I'd recommend the uncut and uncensored versions; you'll probably never see a more twisted nor depraved anime – though personally I just found it enjoyable to watch. It had some interesting characters (such as Münchhausen) and a good story. Old school anime, but extremely violent.
Members of the B.O.D are highly advised to watch it.
The second most violent anime in my opinion would be Apocalypse Zero (the only reason I placed this second is because I found the violence to be not so much as intense but more funny and just gratuitous – which made it weaker to me than Urotsukidoji).
Third would be between Berserk and Elfen Lied. But still, even they fail in comparison to Urotsukidoji and Apocalypse Zero.
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