Which disorder can include symptoms such as ritualistic hand washing and avoidance of dirt?

Obsessive Compulsive Disorder (OCD) is characterized by the presence of intrusive thoughts (obsessions) that lead to repetitive behaviors or mental acts (compulsions) performed in response to those thoughts. Ritualistic hand washing is a common compulsion observed in individuals with OCD, where the person may feel compelled to wash their hands repeatedly to alleviate anxiety or prevent perceived harm associated with dirt or germs.

Avoidance of dirt is also a typical behavior among individuals with OCD, as the fear of contamination can drive them to take significant measures to ensure cleanliness and avoid situations they perceive as dirty. This can significantly interfere with daily life, as these rituals and avoidance behaviors can take up considerable time and effort.

Other disorders listed, like panic disorder or phobias, may involve anxiety, but they do not typically manifest in the specific ritualistic behaviors associated with OCD. For instance, while phobias involve irrational fears, they do not usually include compulsive actions tied to those fears. Narcissistic personality disorder is focused on a pattern of grandiosity, need for admiration, and a lack of empathy, which does not relate to the symptoms described in the question. Thus, OCD is the correct answer due to its specific association with ritualistic behaviors