Very insightful. There is a problem that the OP's numerator is not dimensionally consistent. The D33 term is the partial derivative with respect to nothing, which bothered me. Presuming that D33 should also be the third derivative with respect to t, your approach is even faster and contains no conditional expression.
a[psi_] := k1/(1 + e*Cos[psi]);
d[psi_] := p1/(1 + e*Cos[psi]);
D11 = D[a[x[t]]*(Cos[x[t]]^2 - 1/3), {t, 3}];
D12 = D[a[x[t]]*Cos[x[t]]*Sin[x[t]], {t, 3}];
D22 = D[a[x[t]]*(Sin[x[t]]^2 - 1/3), {t, 3}];
(*D33=D[-a[x[t]]/3]*)(* From the OP *)
D33 = D[-a[x[t]]/3, {t, 3}];
x'[t] = p2/d[x[t]]^2;
x''[t] = D[x'[t], t];
x'''[t] = D[x'[t], t, t];
Et = (D11^2 + 2*D12^2 + D22^2 + D33^2)/(1 + e*Cos[x[t]])^2 //
FullSimplify
Integrate[Et, {x[t], 0, 2*Pi}] // AbsoluteTiming
(* {2.819966958116478`,((1536+20320 e^2+35616 e^4+10988 e^6+315 e^8) \
k1^2 p2^6 \[Pi])/(24 p1^12)} *)