Background <p>Dementia caregiving imposes substantial psychological and emotional burdens on family members. While East Asian studies have examined filial piety and caregiver stress, few have explored how cultural values shape psychological distress and role conflict in depth. This study addresses this gap by examining caregivers’ lived experiences in the Chinese Confucian context.</p> Aim <p>To explore the psychological distress and culturally shaped role conflicts experienced by dementia family caregivers in China.</p> Methods <p>A descriptive phenomenological design was used. Fourteen caregivers were recruited in Chengdu, China, in late 2023 through purposive maximum variation sampling. Data were collected via in-depth individual interviews and analyzed using Colaizzi’s seven-step method.</p> Results <p>Four themes emerged: layered caregiving burden, cultural strain and emotional dissonance, dual emotional experiences of caregiving, and coping strategies and unmet needs. Caregivers reported chronic fatigue, disrupted family roles, and social isolation. Filial piety emerged as a double-edged influence, fostering commitment and resilience while amplifying guilt and discouraging help-seeking.</p> Conclusions <p>Dementia caregiving in Confucian societies entails complex emotional labor shaped by cultural values. Filial piety acts as both a protective and detrimental force, underscoring the need for culturally congruent interventions such as structured dementia education, respite services, and peer or counseling support to safeguard caregivers’ well-being and ensure sustainable care.</p>