Hesitation Marks was never intended to be a direct sequel to The Downward Spiral. Its origin was Trent looking back with 2013 eyes at that album, reflecting on it and the person he was then. It's a follow-up of sorts... just not a 'part two'.

Quote Originally Posted by ninwiki
"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."
"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."

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."