As a writer, Otto has been described as a "democrat", choosing to tell her stories using multiple narrative voices. She has taught at a number of writing workshops during her career. In 1990 she received an Outstanding Teacher Award from the University of California, Irvine; she has also been awarded a number of other prizes and grants during her career. Otto has also been active as an artist, crafting shadow boxes that have been exhibited at a gallery in Portland. She has also spoken of her love for photography and the creative life; though not a photographer herself, she based her most recent novel on the stories of a number of prominent women photographers whose lives she fictionalized.
