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In the self-interview included with the iTunes Deluxe Edition of ''Hesitation Marks'', Reznor spoke of the intentional link that was made between the artwork of the two albums:
<blockquote>"Now in terms of making that connection more literal to ''Downward Spiral'', the choice of reaching out to [[Russell Mills]], later in the process, to actually provide the artwork was certainly a conscious trail of breadcrumbs. The choice of using the same font — we were making the connection here."[]</blockquote>
[[Image:HMstandardaustralian.jpg|thumb|International standard CD artwork]]
[[Image:HMaudiophile.jpg|thumb|thumb|Audiophile Mastered Version artwork]]
This album marks a return to the artwork of [[Russell Mills]], whose work was previously used for ''[[March Of The Pigs (halo)|March Of The Pigs]]'', ''The Downward Spiral'', ''[[Further Down The Spiral]]'' and ''[[Closure]]''. There is a different cover for each of the five editions. Reznor stated in a radio interview[] that he couldn't choose between the various covers and decided to use them all. He also stated that Mills had suggested the album title. A book of prints from the ''Hesitation Marks'' artwork is being put together for release in 2015, entitled ''Cargo In The Blood (The Reverse Is Also True)''.[]
Some of the alternate covers are used within the packaging of the other editions, i.e. the cover of the standard CD is inside the gatefold of the vinyl, the cover of the iTunes Deluxe Edition is on the booklet of the standard CD, etc. The covers of the international and Japanese standard CDs are a variation on the cover of the US standard CD, with the painting oriented sideways and, in the case of the Japanese cover, photographed from a slightly different vantage point and lighter in hue. The digital Audiophile Mastered Version cover is a variation on the standard digital cover, with the painting again oriented sideways.