Otto was born and raised in California to a couple who later divorced;[1] her father was an engineer, while her mother worked in advertising.
[1] Currently she lives in Portland, Oregon with her family,[3] where they moved from San Francisco.
[1] Her first novel, How to Make an American Quilt, was a New York Times bestseller, and was featured on other bestseller lists as well; it was also a New York Times Notable Book, was nominated for the Art Seidenbaum Award, and was adapted into a feature film.
[5] As a writer, Otto has been described as a "democrat", choosing to tell her stories using multiple narrative voices.
Otto has also been active as an artist, crafting shadow boxes that have been exhibited at a gallery in Portland.