Its been a while since I saw this movie, but it seemed pretty cut and dry to me. Marie was crazy. She was suffering from something similar to Dissociative identity disorder. On one hand she was just a normal girl. Alexia was her friend and Marie genuinely wanted to help her escape the killer. Her alternate personality, on the other hand, was a deranged killer and also male. The necrophilia scene probably did happen, but it happened while she was the killer personality not herself.
After I finished the movie I assumed that Marie had actually killed and decapitated that girl while she was the killer, but I guess its also possible that that part was purely in her imagination, although I doubt it. I believe she was killing people prior to her attack on Alexias family. The entire movie took place from Maries point of view. She was completely crazy. Part of her was an insane killer. She imagined this daring rescue of the girl she loved when all along it was really her who was doing the killing and torturing the whole time.
It has been eight years since I've seen the movie, but that's about what I remember of it. I suppose I could be mistaken, though. Also, I'm not saying that there weren't some plot holes or that the medical condition was portrayed realistically, I'm only posting what I took from the movie when I saw it in theaters.
"I have spread my dreams under your feet. Tread softly because you tread on my dreams."
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