The album was first acknowledged by [[Trent Reznor]] on May 28, 2013 in a post on [[nin.com]]:
"I've been less than honest about what I’ve really been up to lately. For the last year I’ve been secretly working non-stop with Atticus Ross and Alan Moulder on a new, full-length Nine Inch Nails record, which I am happy to say is finished and frankly fucking great. This is the real impetus and motivation behind the decision to assemble a new band and tour again. My forays into film, HTDA and other projects really stimulated me creatively and I decided to focus that energy on taking Nine Inch Nails to a new place. Here we go! "< br>
— Trent Reznor, 5.28.13.</blockquote>
In an interview with ''The Guardian''[http://www.theguardian.com/music/2013/aug/08/the-nine-lives-of-trent-reznor], Reznor revealed that the two songs originally written and recorded for the hits package were "Everything" and "Satellite". He also explained what inspired, in his view, a more minimal and sparse treatment of the music:
"What I found the most inspiring was sitting with just a drum machine in my bedroom, in my office. Not having a keyboard or a guitar and playing everything on pads. Me sitting alone with literally one piece of gear just messing around, I found it exciting. It lent to the minimal edge, because it didn't feel like it needed more. "</blockquote>
The album title is a term for wounds that are sometimes made when a person is contemplating suicide by wrist cutting. Fans have speculated that this is either a reference to Reznor being not quite ready to put NIN to rest, or a reference to the fact that the album is conceptually an "upward spiral" and a reflection of the fact that Reznor did not end up killing himself when he was at his lowest point.
In interviews with ''The New York Times'' and ''SPIN'', Reznor stated that he had ''[[The Downward Spiral (halo)|The Downward Spiral]]'' in mind as he worked on ''Hesitation Marks'':
"I felt very aware that it's 20 years later, and I'm still that guy. I know that guy, and I feel for him. I don't resent him, I don't miss him. But how would things feel on the other side of that now, in a much more stable life place, mentally and physically, and with a new family? The incentive has changed. It's not about, 'I'm going to kill myself if I don't get this out of my head. ' But the excavation and the architecture behind it, the motivation behind it, is similar. "[http://www.nytimes.com/2013/07/28/arts/music/nine-inch-nails-is-back-onstage-with-a-vengeance.html]</blockquote>
"For some reason, when I started working more on ''Hesitation Marks'', I started thinking back romantically about who I was when I was writing ''The Downward Spiral''. I was looking back on who I was then and who I am now and how things have turned out, for better or worse. That was the air the new record was born in. I was looking at the other side of how I was not always honest about who I was in the '90s — and I knew I wasn't being honest — and if you sprinkle those negative feelings with some drugs and alcohol, it's usually not a recipe for success. "[http://www.spin.com/featured/trent-reznor-upward-spiral-nine-inch-nails-spin-cover-september-2013/]</blockquote>
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:
"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. "[http://www.spin.com/articles/nine-inch-nails-trent-reznor-in-conversation-with-hesitation-marks-stream/]</blockquote>
In a post on the official NIN Tumblr account[http://nineinchnails.tumblr.com/post/55697135231/each-version-of-hesitation-marks-will-have-its-own], the various artwork was elaborated on by Mills:
"The artworks, (30 mixed media pieces) that I eventually produced towards uses in the ''Hesitation Marks'' releases, evolved out of lengthy exchanges between myself and Trent and in response to the conceptual ideas that thread through the tracks and to the sonic territory that the album explores. I’ve tried to lock into the album’s prevailing mood and echo the album’s essence. The ideas are not communicated in a literal or easily digested form, as this would be boring for me and would insult the intelligence of a potential audience. I’ve tried to make works that obliquely allude to the essence of the subject matter, to its emotional core.
As with my self-initiated works - the paintings, assemblages, collages and multimedia installations - personal ideas and obsessions seep into these works. The organic, the natural, prevailing over or feeding into the industrial, the man made, is a common theme in my work generally and in this instance was particularly apt for the art required.
The works explore ideas of catharsis, of being into dissolution into being, both on a personal and sociological level. They allude to ideas about chaos and order. They deal with ways of suggesting presence in absence. They are a cross between the forensic and a pathology of the personal in which only fragments remain, in which minimal clues can suggest events that may have occurred. They attempt to harness the chaos of a situation, of now, of the personal trauma, of the human condition, into a form that is coherent, a form that accommodates the mess without disguising it as something else. It attempts to capture the essence of these ideas by implication and exclusion. Beneath the form lies the uncertainty and ceaseless flux of the mess, of the chaos.
An amalgam of the contextually-anchored and the process-driven, they are hopefully powerful, arresting, seductive, suggestive and resonant. I hope that they will invite multiple readings.
The titles and materials for the five paintings are as follows:[http://nineinchnails.tumblr.com/post/55697135231/each-version-of-hesitation-marks-will-have-its-own],[http://russellmills.com/russell_mills/albums/art/lures/]
A limited edition art book/multiple containing Mills' art for ''Hesitation Marks'' was released in December 2015. It was priced at $300 and the following information was given on the site set up at cargointheblood.com:
"Nine Inch Nails and long-time collaborator and artist Russell Mills present ''Cargo In The Blood'', a deluxe, limited edition 320-page book collecting all of the works the artist created for Nine Inch Nails’ ''Hesitation Marks'' album. Each volume also includes an original mixed media painting created by Russell Mills specifically for the project. Available exclusively on NIN.com, ''Cargo In The Blood'' is limited to 2000 copies and will be available to order 12/16/15 10am PT. "</blockquote>