4. Full Body ******** - Duke Nukem Forever
It's possible to cross the line from 'distasteful' to 'offensive' incredibly easily, and with the content of Duke Nukem forever you won't be surprised that it's the game's second appearance on this list; and this time it has crossed that line.
For this achievement you don't actually have to do anything questionable as a player, in fact you end up being rewarded it for something you do by accident. In order to achieve the 'reward' in question, you have to get knocked down ten times. Easy enough and totally innocent right? You'd think so.
Unfortunately the game uses this opportunity to make a distasteful joke about Tourette Syndrome, giving you the achievement 'Full Body Tourette's' to mark your tenth knock-down. It's generally understood that it is offensive and inappropriate to make jokes about Tourette's, or any other neurological disorder for that matter - but unfortunately, 2K Games didn't get the memo.
For all your trespasses playing this game, you probably don't want an outdated and offensive riff about Tourette's branded onto your record for all to see.