Spoiler alert! This is my understanding of the movie. It may not be the actual interpretation. I'm just expressing my thoughts here.
PTSD is a Post Traumatic Stress Disorder, in which the patient experiences stress and it's related symptoms whenever he/she is exposed to the incidents/news/situations related to one particular trauma. In this movie, the trauma is Tapsee harassed by some guy exactly one year back from the current timeline, at the new year eve and she's mentally affected by that event even though the guy who did that was arrested and is in prison for his crime. We also have to note that Tapsee got her a tatoo in her wrist exactly at that day when she was harassed (since she wore same outfit during tattooing and when she was harassed). Tattooing usually causes some burning sensation & pain at the site. She experienced these signs prior to & during that harassment last year. We are also showed that there's a serial killer out there who beheads lone women and burns the body after beheading. It seems that psycho killer is still out there continuing his killings (we can see that in a news report when tapsee was shown working). The actual plot began when her maiden told her about the coming new year. It's the stimuli/root cause that triggered the Stress (PTSD) in tapsee after one year (which the psychiatrist clearly explains in the movie itself). The burning sensation & pain at the tattoo site are all signs of PTSD, i.e., they are all imagined by Tapsee as a part of PTSD. To be clear, the fear that the past event (being harassed) might recur in the coming new year day makes her to subconsciously develop the exact signs she had (burning sensation & pain at the tattoo site) last year before & at the time of harassment. Now i am coming to climax, The three serial killers & three lives tapsee get are all in her imagination. Three lives & Three serial killers, she imagined them from the Pac-Man game she plays. It's more like a Defence mechanism to overcome her PTSD. You may ask why Tapsee uses serial killer plot in her imagination to fight. This is because she has a memorial tattoo of a victim of that killer. You may also ask how Tapsee came to know about the methods by which serial killer kills his victim (burning after beheading). In a scene when Tapsee's maiden was watching the news report of that serial killer, Tapsee was in the hallway working. She might've heard about that then.
My conclusion : This is a movie which explains how a PTSD patient overcomes her stress by fighting back in her imagination with the help of Pac-Man & the actual serial killer. I was actually waiting for a final scene where Psychiatrist tells that she overcame the stress by some defence mechanism. But it didn't happen. The director left it for us to interpret it. Imo, this isn't a fantasy-supernatural-horror movie. It's a psychothriller-slasher movie in which a PTSD patient utilises the actual serial killer's existence and Pac-Man's 3 lives in her imagination to overcome her stress reactions. A brilliant movie indeed but director should've concluded the movie in the way in which he wanted it to be. There are movies like Enemy, American Psycho, The Machinist which all are left open to viewers' interpretation but this is one fine well executed plot which has to be concluded in it's genre, otherwise we may confuse it as an horror or a fantasy or a supernatural movie, which it isn't.