
Source: http://cakewrecks.blogspot.com/2011/03/like-boss.html
I think it was for a therapist who works with sociopaths. That's one of only two cases I know in which it would be appropriate to write that word on a cake (the other being the celebrated unveiling of the Moral Absolute, which we all know will never happen in our lifetime if at all

Edit: Actually, I think it's supposed to look like a person falling into a hellhole. Am I allowed to say hellhole on this site? Don't ban me, mods!