Context: Severe self-mutilation episodes are rare in psychiatric practice. Most patients are psychotic during such acts and the main diagnosis is schizophrenia. The regions most commonly self-mutilated are the penis and the eyes. Case report: A patient previously diagnosed with schizophrenia started self-mutilating his lip and phalanxes secondary to command auditory hallucinations and influenced by mystic-religious delusions. Conclusion: Self-mutilation episodes are rare in schizophrenic patients. In such case, it should be identified prodrome symptoms or provoking situations in order to promptly institute strategies to prevent or lessen the risk of new episodes.