It was founded by conservative members of the Presbyterian Church in the United States of America (PCUSA), who objected to the rise of Liberal and Modernist theology in the 1930s.

Machen, who, prior to this time was a PCUSA minister, had a longstanding distrust of liberalism in Christianity, as typified by the Auburn Affirmation.

In 1935, the PCUSA General Assembly declared Machen's Independent Board unconstitutional, and gave the associated clergy an ultimatum to break their ties with it.

Later that year, a faction led by Carl McIntire broke away to form Bible Presbyterian Church, affirming total abstinence from alcohol and premillennialism.

[1] The OPC has 17 Presbyteries across Canada and the United States: Central Pennsylvania, Connecticut and Southern New York, the Dakotas, Michigan and Ontario, Mid-Atlantic, Midwest, New Jersey, New York and New England, Northern California and Nevada, Northwest, Ohio, Philadelphia, South, Southeast, Southern California, Southwest, and Wisconsin and Minnesota.

[16] Greg Bahnsen was also a key figure in the Christian Reconstructionism movement, with an emphasis of applying God's law to contemporary civil and legal matters.

"[18] The 68th General Assembly in 2001 declared “that the use of women in military combat is both contrary to nature and inconsistent with the Word of God,” [19] In 2006-2007, a study committee formed by the General Assembly created a report that concluded that "the church should never turn its back on fellow brothers and sisters in Christ, whether they are legally or illegally in the country.

The duties of the Session include overseeing public worship, the administration of Baptism and The Lord's Supper, the addition, removal, and discipline of members, and keeping records of membership.

[22] All of the members of local congregations and its ministers are organized by geography into a regional church, and the presbytery serves as its governing body.

[26] The other duties of the General Assembly include organizing regional churches, calling ministers and licentiates to missionary or other ministries, and reviewing the records from the presbyteries.

[32] One of the OPC's goals is that "indigenous Reformed churches be established which will provide fellowship and instruction, and make the gospel known in its own culture and in others".

[33] The OPC's Committee on Home Missions and Church Extension also serves to help sustain and plant congregations in the United States and Canada.

Their duty is to aid presbyteries in planting congregations, finding pastors, purchasing property and church buildings, and assisting home missionaries.