The long-term stability of alpine treeline positions and increased stem density are frequently reported by recent studies; however, whether a denser treeline forest is relevant to competitive tree–tree interactions remain unclear. Herein, we mapped and surveyed individual trees in two undisturbed Smith fir (Abies georgei var. smithii) treeline plots (with a size: 30 m × 200 m; plot NE1: 4477 m, NE2: 4451 m) near Ranwu Lake (RW) on the southeastern Tibetan Plateau. The surface pattern method and spatial point pattern analysis were used to detect the spatial distribution patterns of three size classes (seedlings, juveniles, adults) and spatial associations between the pairwise size classes. We also compared our results to the spatial patterns of the five other treeline forests (Deqin, Linzhi, Changdu, Yushu, Aba) reported from the Tibetan Plateau. Young trees dominated the two fir treeline plots. Both positive and negative spatial autocorrelations for all of the trees were detected in two study plots. Intraspecific facilitation and competition coexisted at the fir treelines in three forest regions (RW, Linzhi, Aba) characterized by a mild moist climate, whereas intraspecific facilitation dominated the other three forest regions (Changdu, Deqin, Yushu), which featured seasonal climatic stress or high disturbance pressure. Thus, increased stem density at alpine treeline can be linked to competitive interactions in relatively favorable environmental conditions. Overall, the spatial patterns of the treeline population are mainly shaped by the combination of thermal and moisture conditions and are also modulated by non-climatic variables (e.g., disturbance history and microtopography).