The high-quality interaction of urban reality human settlements (RHSs), pseudo-human settlements (PHSs) and image human settlements (IHSs) can better explain the constantly updated human settlements phenomena under the human–land-relationship regional system. At present, the basic connotation, empirical exploration and optimized path of high-quality and coordinated development of “three states” of human settlements are not clear. In this paper, we take 14 prefecture-level cities in Liaoning Province as case areas and empirically explore their spatial patterns, coupling and coordination spatial relationships, driving mechanisms and development paths by using a coupling and coordination model, the entropy weight method and the geographic detector method. The results indicate that: (1) The spatial pattern of high-quality development of “three states” of human settlements varies significantly in different regions, forming a “dual-core” and “hump” spatial structure. (2) RHSs, PHSs and IHSs are not completely coordinated, forming “high–high–high” and “low–low–low” types, represented by Shenyang and Fuxin. (3) The high-quality coordinated development of “three states” of human settlements is driven by economic conditions, population conditions, entertainment systems and other factors. The population system, the social communication system and the support system, respectively, lead the high-quality coordinated development of RHSs, PHSs and IHSs.