The real reasons Selena Gomez ended up in rehab

In October 2018, TMZ reported that Selena Gomez was being treated for mental health issues following an "emotional breakdown" at Cedars-Sinai Medical Center in Los Angeles. Gomez reportedly was "despondent" and "emotional" over what the tabloid called an alarmingly low white blood cell count related to her kidney transplant and struggles with lupus. Sources told the site that Gomez did not want treatment, claiming she "freaked out" and attempted to rip an IV from her arm.

"She has had a tough few weeks and the panic attack in the hospital was the tipping point," a source told People. "She realized she needed to seek additional help for her ongoing emotional issues. She's surrounded by close family and has a lot of support. She's doing better now and is seeking treatment on the East Coast." A Gomez insider told Entertainment Tonight that her circle is optimistic about the singer's recovery. "Selena is a fighter and we will be back in no time, but for now she is listening to the doctors and staying healthy with exercise, a diet plan and being monitored by doctors at the facility." 

We applaud her decision to seek out help to improve her health and wellness. Here's what we know about Gomez's condition and what got her to this point.

She struggles with lupus and mental health issues

Gomez's kidney transplant (which she revealed publicly in September 2017) was due to her struggles with lupus. TMZ reported that the singer was in "dire straits" before getting her transplant that June, and that she was hospitalized for kidney failure in May 2017, while visiting then-boyfriend The Weeknd in Chicago. At the time, Gomez was reportedly already on a waiting list for a kidney transplant. Her close friend, actress Francia Raisa, became her donor. 

But the procedure wasn't without its complications. In addition to the aforementioned problems with Gomez's white blood cell count, there were also complications immediately following the transplant. In the March 2018 issue of W magazine, Raisa recalled those frightening moments. "A few hours after our surgery, I woke up and had a text from her that said, 'I'm really scared.' My kidney was very active, and when she turned, she broke an artery. They had to take her into emergency surgery and get a vein from her leg and build a new artery to keep my kidney in place. She could have died."

She's undergoing dialectical behavior therapy

TMZ and People reported that part of Gomez's mental health treatment plan involves dialectical behavior therapy (DBT). Psychology Today reports that the practice was developed as a method to treat borderline personality disorder but has since been used to treat several mental health issues, including depression, binge-eating, bulimia, bipolar disorder, post-traumatic stress disorder, and substance abuse. DBT teaches patients about mindfulness, healthy communication and behavioral patterns, emotional regulation and how to better respond to negative events and feelings in a healthy way.

Gomez has been open about DBT, telling Vogue in 2017, "DBT has completely changed my life. I wish more people would talk about therapy. We girls, we're taught to be almost too resilient, to be strong and sexy and cool and laid-back, the girl who's down. We also need to feel allowed to fall apart."

She gave an alarming fan Q&A

In September 2018, Gomez opened up to her fans in a very raw and somewhat worrisome Instagram Live (via the Daily Mail), "Depression was my life for five years straight. Depression and anxiety was the forefront of everything that I did in my life. Every single thing…" Elsewhere in the video she cried a lot, complained about press, and tried to offer advice to others.

When a fan asked her for tips on on how to forget someone, Gomez replied, "Well, you can't really just like, forget … you kind of have to figure out why you're still holding onto them. Like, why do you want to forget them? I think that's where you start … As far as losing someone, I mean, you never [forget.] Sometimes forgetting can be a bad thing; sometimes you need to be reminded of something."

The pressures of fame got to her

Part of what may have led to Selena Gomez's meltdown was the notion that she may never feel like she can truly relax or take a break from working. "She's genuinely so nice, thoughtful and sweet but she feels responsible for a lot of other people, and has since a young age. There's a lot [of] pressure," an insider told Us Weekly. "She's sensitive; she also doesn't want to do a big press run and get asked about things that she doesn't want to talk about."

Gomez has made no secret that she doesn't want to be famous anymore, but often in somewhat ironic, if not all-out hypocritical, ways. For example, she told Vogue in its April 2017 cover story, "I just really can't wait for people to forget about me." In her September 2018 Instagram live session, Gomez also lamented that she never wants to be on a magazine cover ever again.

She admitted that she's drinking again

A source told Page Six in May 2018 that Selena Gomez was abstaining from alcohol after going to rehab that February. If that was true, it apparently didn't last.

"As far as my personal life, someone sees me having a glass of wine? I could give two s**ts," she told Elle in its October 2018 profile. "I'm not trying to hide. That's my life."

Sources told Radar Online that Gomez's partying and drinking allegedly contributed to her low white blood cell count that triggered her October 2018 breakdown. "Doctors have all told her she needs to stop," an insider claimed. "Her family says she needs to stay sober, or she could die."

She's been in and out of rehab in 2018

Gomez reportedly went to the same East Coast psychiatric facility in October 2018 that she visited earlier that year. A source told Us Weekly that the singer was treated for depression and anxiety during her prior stay. In fact, Gomez has talked about that previous experience. "Anyone who knows me knows I will always start with my health and my well-being. I've had a lot of issues with depression and anxiety, and I've been very vocal about it, but it's not something I feel I'll ever overcome," she told Harper's Bazaar. "There won't be a day when I'm like, 'Here I am in a pretty dress — I won!' I think it's a battle I'm gonna have to face for the rest of my life, and I'm OK with that because I know that I'm choosing myself over anything else."

Understanding her history, those close to Gomez have reportedly been monitoring her condition. "Selena has dealt with depression for a while and her and the people around her have always kept an eye on how she feels, even more so since her kidney transplant," an insider told Entertainment Tonight. "Selena wasn't feeling well and went to the hospital, as she does whenever she feels off. After further monitoring, it was decided that Selena would seek treatment at a [mental health] facility."

It's her fourth time in treatment overall

Selena Gomez's treatment history has, at times, been shrouded in mystery — or in layman's terms: privacy. As Nicki Swift previously reported, there were mixed messages surrounding her previous stint in rehab in September 2016. Gomez and her camp insisted she was seeking treatment for emotional problems, but sources allege she's struggled with substance abuse in the past. 

Gomez previously sought treatment in early 2014 for what she claimed were struggles with lupus, but insiders say the singer had other problems too. "Her friends and family became increasingly worried that there might be a serious problem with Selena," a source told Radar Online. "…The partying was, at times, wild. They wanted to help her — and they very much encouraged her to go to rehab." Star claimed Gomez smoked weed frequently with her ex, Justin Bieber. A source told Radar Online the former Disney darling was allegedly "experimenting with marijuana and prescription drugs, including Xanax and Ambien." Insiders also told TMZ that Gomez also sought treatment for alcohol abuse.

Of course, all of this is the stuff of tabloid gossip. What's most important — whatever the issue may be — is that Gomez receive the treatment she needs to feel her best.

She has a 'complicated relationship' with social media

In September 2018, Selena Gomez posted a headline-making religious message on Jennifer Lopez's Instagram. After seeing J-Lo in concert, Gomez wrote (via Page Six): "I wanted to tell you how much you inspired me tonight!!! I haven't felt that free in my entire life … I just want to tell you how amazing God thinks you are. He was speaking to me through your show tonight!!" Gomez also shared a screenshot of that message on her own Instagram Stories, tagging Lopez.

Not long after that post, Gomez was back on Insta to announce a hiatus. "Taking a social media break. Again," she said. "As much as I am grateful for the voice that social media gives each of us, I am equally grateful to be able to step back and live my life present to the moment I have been given. Kindness and encouragement only for a bit! Just remember- negative comments can hurt anybody's feelings. Obvi." 

Gomez has struggled with social media for years, telling Harper's Bazaar that her relationship with the platform is "complicated." A source told People that Gomez's personality can make online communication a risky endeavor. "She has certain triggers and is also a very sensitive person which is why she cuts herself off from social media," the insider said. "The negativity and hate she gets affects her more deeply than most celebrities because she takes everything to heart."

Her relationship with the press is strained too

Social media isn't the only minefield for Gomez. The pop star lashed out at Elle magazine over an October 2018 cover story. Though the piece focused on Gomez's work with the A21 organization to stop human trafficking, the article also mentioned her well-known association with the Hillsong church. Gomez apparently did not appreciate the nod to her spirituality, posting a disgruntled and somewhat confusing response on her Instagram.

"Speaking from my heart for over an hour to someone who puts those thoughts into paid words can be hard for me. The older I get the more I want my voice to be mine," Gomez said, noting that the "purpose" of her interview was to "my work with A21, my new collection with Coach, and some new music." Gomez claimed she "rarely" mentions church and did not do so during said interview,

"but I'll always feel comfortable talking about my values and beliefs. I respect that from everyone and anyone. I understand that reporters are working to grab the attention of a reader, however I will always work to ensure that what is public represents my truth. I'm a bit bummed but rarely surprised."

Her reaction was a bit baffling because the story had barely touched on her spirituality. Not to mention, this is the gal who carried a purse with a Biblical message on it to the 2018 Met Gala and also dropped the aforementioned religious message on Jennifer Lopez's Instagram.

Her exes have all moved on

Selena Gomez's recent breakdown may have been triggered, in part, by her exes very publicly moving on. Gomez split from her on-again-off-again beau, Justin Bieber, seemingly for good in March 2018. Six months later, he married Hailey Baldwin. A source told Radar Online that Gomez's mother, Mandy Teefey, believes her daughter's October 2018 meltdown was precipitated, at least in part, by her heartbreak over Bieber's marriage. Insiders also claimed Bieber reached out to Teefey to check on Gomez's condition and is even considering visiting his former flame.

"Justin was very upset when he heard the news about Selena," a source told Entertainment Tonight. "Selena holds a special place in his heart. Justin spent most of the day alone, and even took a solo hike to the Wisdom Tree in L.A. to get away and decompress. Justin then went to his church where he was noticeably upset … Above everything Justin wants the best for Selena. When the two rekindled their romance, he got to see how her health really affects her, so he understands how serious this is."

The Weeknd, who Gomez dated before reuniting with Bieber for the last time, has been packing on the PDA with model Bella Hadid, who he dated before going for Gomez. That's gotta sting at least a little bit.

She lost several people close to her within a short time

Gomez was close with singer Christina Grimmie, The Voice contestant who was murdered in the summer of 2016. According to Billboard, Gomez broke down in tears onstage in June 2016 and dedicated a song to Grimmie, weeping, "When she was 14, we met her and my parents and I signed her … I don't really understand how this really happened."

There have been other losses within Gomez's circle as well. In November 2015, her makeup artist, Jake Bailey, committed suicide, reported TMZ. In December 2011, Gomez's mom suffered a late-term miscarriage, which devastated the family. Gomez later admitted to GQ that the miscarriage, as well as her lupus, contributed to her first trip to rehab in 2014.

Gomez was also shaken by friend Demi Lovato's drug overdose in July 2018. A tearful Gomez told Elle: "All I'm saying is, I reached out personally. I didn't do a public thing. I didn't want to. I … I love her. I've known her since I was seven. So … it's … that's what I'll say." A source close to Gomez told Radar Online that Gomez "freaked out" after Lovato's overdose because "it could have been her."