This study is one of the first to examine the relationship between independent clinical ratings of Childhood Sexual Abuse (CSA) severity and Borderline Pathology (BP) with Rorschach Inkblot Method variables that assess reality testing, affect regulation, relational functioning, and traumatic content. Participants in this study were 60 outpatients seeking treatment at a university-based community clinic. All Rorschach protocols were scored using the Exner Comprehensive System, and interrater reliability for all variables was in the excellent (ICC ≥ .75) range. Results demonstrated some limited reality testing impairments in relation to CSA severity. CSA severity was found to be most strongly related to affect regulation variables on the Rorschach. Degree of BP was most strongly related to variables examining relational functioning and object representations on the Rorschach. Traumatic content and oral dependency variables on the Rorschach were not significantly related to either CSA severity or BP. In addition, none of the Rorschach variables examined adequately assessed the interaction of these two criterion variables (CSA severity and BP). Clinical implications are explored and discussed.