Speaking with Eurogamer, Alice's creator American McGee explained that while the game will deal with very mature and adult themes, it isn't going for over-the-top blood and gore just "for the sake of getting an M rating".
"The first Alice, we never set out to get an M-rating. It was more about trying to be true to the fiction that we created from the well known books.
"This time around it's the same thing: we're trying to be true to this version of Alice that we've created and the world in which she lives and the problems she has. That means we are going to be dealing with what you could call adult or mature topics; she's not living a happy or easy life.
"But that being said, we're not trying to go over the top and use blood and gore and violence just for the sake of getting an M rating. This will be an M title, but it's going to be in the sense of mature, adult content, not over the top violent, horror content," he added.
Alice: Madness Returns was announced at EA's Summer Showcase in July and will be out in 2011 for the PS3, Xbox 360 and PC.