American release is censored. My only clue anything would happen was Guts looking really insane, but he looks like that anyway.
I wish some one fucking warned me.
Also, in the American release of the volume of the manga with that image which I can't post cause it has tits, they censored the tits by putting a sticker over it. But they left the rest intact.
They left in the severed arm, gouged out eye, and scores of various wounds of Guts body. Because that's not offensive at all. Tits, however, are evil.