Mental distress and disorders in sports can manifest as both sport-specific and non-sport-specific disorders. These conditions may impair performance and increase the risk of physical injury. If unrecognized or inadequately treated, mental health disorders can lead to severe long-term consequences for athletes. In certain sports, the prevalence of mental disorders even exceeds that of the general population. However, competitive athletes are significantly underrepresented in psychiatric healthcare due to systemic barriers, including fear of failure, career-related anxieties, and a culture that often subordinates personal needs to athletic demands. Consequently, athletes typically seek help only when mental distress impairs performance. To address this, proactive intervention during subclinical phases is essential for maintaining both mental health and elite success. Accordingly, a structured, multi-stage sports-psychiatric diagnostic framework in competitive sports is required to enable the detection of mental disorders using established examination and screening methods before a decline in performance occurs. Established assessment methods as well as those currently under development are presented. These include structured, categorical, multi-stage procedures, baseline assessments, and dimensional methods. It is demonstrated that the prevention of mental disorders and subsequent performance drops is best achieved through continuous sports-psychiatric support within the sports system. In this context, operationalized psychodynamic diagnostics proves to be a valuable dimensional tool that also enables performance-related intrapsychic potential analyses and supports the early identification of even subclinical psychological pathologies.