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If you're asking about the severed head felatio scene, it might seem disconnected and strange since the killer is nowhere near the man in the truck at the time.
Marie is at least in pursuit or retreat from the man throughout the rest of the movie, making her the presence of her alter ego appear more feasable.
However it is hardly such a stretch of the imagination to consider that her Dissociative Identity Disorder can conjour up such thoughts... and that the filmmakers may dare to illustrate them. The scene might have been included to remove any possibility of viewers guessing the twist (which of course nobody did), but it also serves to deepen Marie's psychosis even further when we rewind at the end of the film. Replaying Haute Tension in our heads and watching it for the second time is a whole new experience.
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