Primary doctrinal distinctions which separate the RPCNA from other Reformed and Presbyterian denominations in North America are: its continued adherence to the historical practice of Reformed Christianity, contained in the Westminster Confession of Faith, of practicing exclusive psalmody, and its continuing affirmation of Jesus as mediatorial king, ruling over all nations.

Prior to the 1960s, the RPCNA refused to vote in elections or participate in government in the United States due to it not directly acknowledging Christ's authority over it, and since has continued (at some times more heavily than others), to lobby the federal government to expressly submit to the authority of Jesus Christ in the United States Constitution.

Each minister (teaching elder), whether serving as the pastor of a congregation or not, is automatically a delegate to his presbytery and to the synod.

From the time of the Revolution Settlement in 1691, the foremost of Reformed Presbyterian "distinctive principles" was the practice of political dissent from the British government.

During the American Revolution, most Reformed Presbyterians fought for independence—the one minister that served in South Carolina was even arrested for insurrection and brought before Lord Cornwallis in 1780.

Therefore, the RPCNA eschewed various civic rights, such as voting and jury service, and church courts disciplined members who exercised them.

Abolition was a major factor in the decline of the denomination's South Carolina and Tennessee congregations: most members there, finding it hard to be abolitionists in slave-owning societies, moved to southern Ohio, Indiana, and Illinois; by the beginning of the Civil War, all of the old congregations in South Carolina and Tennessee were gone.

Immigration from Reformed Presbyterian churches in Ireland and Scotland provided sustained growth for the denomination.

Typically, a large group of settlers would gather and move to an area favorable for farming, where a congregation would soon be organized for them.

Settlement and growth in the western United States continued for a time, with new presbyteries being organized in Colorado, the Pacific Coast, and the Prairie Provinces of Canada.

Historically, the "distinctive principles" of Reformed Presbyterians were political: they held to a continuing obligation of the Covenants, both National and Solemn League, upon all who had sworn them and upon all their descendants, and the belief that governmental rejection of such documents caused the government to become immoral or even undeserving of obedience.

This led them to reject the government of Scotland after the Glorious Revolution, as well as those of Ireland and England, which had also acknowledged but later dropped the Covenants.

Furthermore, as the American colonies had been under English jurisdiction at the time of the Solemn League, the United States was held as responsible to uphold the Covenants.

Since the Constitution contains no reference to Christ or to the Covenants, Reformed Presbyterians refused to vote, hold governmental office, serve on juries, or swear any oath of loyalty to the United States government or any lower government; Canadian members similarly refrained from such activities.

[5][6] Another long-held belief distinguishing the RPCNA from other churches was its prohibition of occasional hearing, the practice of attending worship services or preaching by ministers of other denominations.

For example, records from an eastern Pennsylvania congregation note that two women were "severely admonished" for attending a weekday Methodist camp-meeting in 1821.

[8] While this practice was not unusual in past centuries, many other denominations have permitted hymns and instrumental music over the years.

Today, the RPCNA has congregations in twenty-eight U.S. states and three Canadian provinces throughout North America, as well as maintaining close relations with "sister churches" of Reformed Presbyterians in South Sudan, Ireland, Scotland, and Australia.

The RPCNA is composed of the following presbyteries:[9] Since 1980, the denomination has experienced growth, seeing an increase of approximately 25% in membership and 11% in the number of churches.

In North America, several different home missions were established among specific people: Several other missions were organized for foreign work: Other missionary works supported by the RPCNA include the National Reformed Presbyterian Church of Bolivia and Reformed Presbyterian Church in Chile.

Fraternal relations are maintained with the following bodies:[13] From 1946 through 2008 inclusive RPCNA held membership in the National Association of Evangelicals.