Atlus is making its adult role-playing game Catherine as suggestive as possible. What does a tiny man with ram horns stuck in a woman's cleavage suggest to you?
Catherine is an adult Persona spin-off that deals with sex, dreams, and murder, so I suppose this Japanese box art conveys those themes in some fashion. The sex part is obvious, and I suppose the dreams are represented by the fact that protagonist Vincent is climbing giant women, something that doesn't happen often in real life. Oh, and look! The logo has blood drops. Mission accomplished!
Will this cover art make it to North America? Hell, will the game make it to North America?
You don't think Atlus would ignore the overwhelming response North American gamers had to images like these, would you?