This study investigated whether sensory realism cues in violent games – blood color (red vs. blue), screams of pain (on vs. off), and player perspective (first-person vs. third-person) – affect players’ physiological arousal (i.e., skin conductance levels), spatial presence (i.e., sense of being physically ‘‘there’’), and state aggression in a popular violent game (Half-Life 2), controlling for users’ prior game experiences. A path model (N = 160) was examined to see the mediation effects of arousal and presence between realism cues and state aggression. In line with the general aggression model, results showed that realistic blood color and screams increased arousal, but no effect was found for first-person perspective. Presence significantly affected users’ state aggression. However, contrary to our expectation based on the excitation transfer theory, arousal did not show any significant effect on aggression. In addition, presence mediated the influence of realistic blood color on state aggression. In the effects of graphic realism of violence on user aggression, presence did a crucial role. Implications and future studies were discussed.